{ "hospital_name": "Roxborough Memorial Hospital", "last_updated_on": "2024-06-21","version": "2.0.0", "hospital_location": ["Roxborough Memorial Hospital"],"hospital_address": [ "5800 Ridge Avenue Philadelphia, PA 19128" ], "license_information": { "license_number": "454246163", "state": "PA" }, "affirmation": { "affirmation": "To the best of its knowledge and belief, the 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 indicated.", "confirm_affirmation": true } , "standard_charge_information": [ { "description": "Vaccine administration", "code_information": [ { "code": "0001A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.54,"maximum": 40,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 18.63, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 17.96, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7.54, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" }]}]} , { "description": "Vaccine administration", "code_information": [ { "code": "0002A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.54,"maximum": 40,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 31.23, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 30.09, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7.54, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" }]}]} , { "description": "Vaccine administration", "code_information": [ { "code": "0003A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.54,"maximum": 40,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7.54, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40, "methodology": "fee schedule" }]}]} , { "description": "Liver dis 10 assays w/nash", "code_information": [ { "code": "0003M", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2517, "discounted_cash": 654,"minimum": 18.16,"maximum": 2013.6,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 503.4, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 604.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 503.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1026.94, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 503.4, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 553.74, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 402.72, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1384.35, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 523.54, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 528.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 503.4, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 780.27, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 503.4, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1384.35, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 755.1, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1384.35, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 704.76, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 503.4, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1195.28, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 503.4, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 503.4, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 503.4, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 755.1, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1006.8, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 503.4, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 518.5, "methodology": "fee schedule" }]}]} , { "description": "Vaccine administration", "code_information": [ { "code": "0004A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.54,"maximum": 40,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7.54, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "001", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 18307.2,"maximum": 421573,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303023, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 233094, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 233094, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 421573, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279713, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 314344, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 18307.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 297066, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 233094, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244749, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 244749, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 240087, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 233094, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 233094, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 332012, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 233094, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 361296, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 233094, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 233094, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 233094, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 328131, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 328131, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242418, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 358271, "methodology": "case rate" }]}]} , { "description": "LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT ", "code_information": [ { "code": "0011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 73703,"maximum": 4.07695e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.07695e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.88281e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.88281e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.88281e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 73703, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.88281e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.07695e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.88281e+008, "methodology": "case rate" }]}]} , { "description": "Vaccine administration", "code_information": [ { "code": "0011A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.54,"maximum": 40,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7.54, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 17.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 18.63, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" }]}]} , { "description": "LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT ", "code_information": [ { "code": "0012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 78039.7,"maximum": 4.68888e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.68888e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.4656e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.4656e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.4656e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.4656e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.68888e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.4656e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 78039.7, "methodology": "case rate" }]}]} , { "description": "Vaccine administration", "code_information": [ { "code": "0012A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.54,"maximum": 40,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 32.08, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 30.09, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 31.23, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7.54, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40, "methodology": "fee schedule" }]}]} , { "description": "LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT ", "code_information": [ { "code": "0013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 91727.5,"maximum": 5.83682e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.55887e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.83682e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.55887e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 91727.5, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.55887e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.55887e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.55887e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.83682e+008, "methodology": "case rate" }]}]} , { "description": "Vaccine administration", "code_information": [ { "code": "0013A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.54,"maximum": 40,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7.54, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT ", "code_information": [ { "code": "0014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 162740,"maximum": 1.24771e+009,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.18829e+009, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.18829e+009, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.24771e+009, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.24771e+009, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.18829e+009, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.18829e+009, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 162740, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.18829e+009, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "002", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21302.8,"maximum": 190481,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 166982, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 108668, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 110778, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 163530, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 21302.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 110778, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 105503, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 142032, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 105503, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 105503, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 105503, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 105503, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 109723, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 126604, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 105503, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 150015, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 151173, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 166982, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 190481, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 105503, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 161879, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 137154, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 105503, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 105503, "methodology": "case rate" }]}]} , { "description": "HEART &/OR LUNG TRANSPLANT ", "code_information": [ { "code": "0021", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 89049.1,"maximum": 7.74326e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.37453e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.74326e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.37453e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.37453e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 89049.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.37453e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.37453e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.74326e+008, "methodology": "case rate" }]}]} , { "description": "Vaccine administration", "code_information": [ { "code": "0021A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.54,"maximum": 40,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 17.96, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 18.63, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7.54, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "HEART &/OR LUNG TRANSPLANT ", "code_information": [ { "code": "0022", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 114790,"maximum": 8.41984e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.01889e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.01889e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.41984e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 114790, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.01889e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.01889e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.41984e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.01889e+008, "methodology": "case rate" }]}]} , { "description": "Vaccine administration", "code_information": [ { "code": "0022A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.54,"maximum": 40,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7.54, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 30.09, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 31.23, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" }]}]} , { "description": "HEART &/OR LUNG TRANSPLANT ", "code_information": [ { "code": "0023", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 137942,"maximum": 1.15697e+009,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.10187e+009, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.10187e+009, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.15697e+009, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.10187e+009, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.10187e+009, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.15697e+009, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 137942, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.10187e+009, "methodology": "case rate" }]}]} , { "description": "HEART &/OR LUNG TRANSPLANT ", "code_information": [ { "code": "0024", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 217484,"maximum": 2.06051e+009,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 217484, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.96239e+009, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.06051e+009, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.96239e+009, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.96239e+009, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.96239e+009, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.06051e+009, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.96239e+009, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15934,"maximum": 331680,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 331680, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 183462, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 15934, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 227465, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 183462, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 183462, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 183462, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 238501, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 192635, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 183462, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 205930, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 183462, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 220155, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 183462, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 188966, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 284366, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 190801, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 261216, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 281876, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 183462, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 227465, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 247315, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 183462, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 192635, "methodology": "case rate" }]}]} , { "description": "Vaccine administration", "code_information": [ { "code": "0031A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.54,"maximum": 40,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7.54, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 30.09, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 31.23, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 28.39, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" }]}]} , { "description": "Vaccine administration", "code_information": [ { "code": "0034A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.54,"maximum": 40,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7.54, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "004", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11035.3,"maximum": 228688,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 11035.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 128668, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 126598, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 132928, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 126598, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 126598, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 228688, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 132928, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 164577, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 194349, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 130396, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 170520, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 180104, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 126598, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 126598, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 151917, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 131662, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 126598, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 126598, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 142123, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 126598, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 142123, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 126598, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 196227, "methodology": "case rate" }]}]} , { "description": "TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE ", "code_information": [ { "code": "0041", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 52199.4,"maximum": 4.25497e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.25497e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.05235e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 52199.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.05235e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.05235e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.05235e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.05235e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.25497e+008, "methodology": "case rate" }]}]} , { "description": "TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE ", "code_information": [ { "code": "0042", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 71018.5,"maximum": 4.79484e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.56651e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.56651e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.56651e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.79484e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.56651e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.79484e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.56651e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 71018.5, "methodology": "case rate" }]}]} , { "description": "Ct perfusion w/contrast cbf", "code_information": [ { "code": "0042T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4439,"minimum": 18.16,"maximum": 3551.2,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3551.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2441.45, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2441.45, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 3551.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1331.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2441.45, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE ", "code_information": [ { "code": "0043", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 103022,"maximum": 7.77034e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 103022, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.40032e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.77034e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.40032e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.40032e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.40032e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.40032e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.77034e+008, "methodology": "case rate" }]}]} , { "description": "TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE ", "code_information": [ { "code": "0044", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 148223,"maximum": 1.23916e+009,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.18015e+009, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.18015e+009, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 148223, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.18015e+009, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.18015e+009, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.18015e+009, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.23916e+009, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.23916e+009, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "005", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14789.6,"maximum": 161015,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 116004, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 14789.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 89234, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 89234, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 89234, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 93695.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 161015, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 89234, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 127672, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 136837, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 91911, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 89234, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 92803.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 120060, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 89234, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 107081, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 89234, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 89234, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 138313, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 126808, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 115584, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 93695.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 89234, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 127672, "methodology": "case rate" }]}]} , { "description": "TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE ", "code_information": [ { "code": "0051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 50138.8,"maximum": 2.86231e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.86231e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 50138.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.72601e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.72601e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.72601e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.86231e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.72601e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.72601e+008, "methodology": "case rate" }]}]} , { "description": "TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE ", "code_information": [ { "code": "0052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 55709.8,"maximum": 3.68653e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.51098e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.51098e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.51098e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.51098e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.68653e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 55709.8, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.51098e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.68653e+008, "methodology": "case rate" }]}]} , { "description": "TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE ", "code_information": [ { "code": "0053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 68179.1,"maximum": 5.58323e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.31736e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.31736e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.31736e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.58323e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.31736e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.31736e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.58323e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 68179.1, "methodology": "case rate" }]}]} , { "description": "TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE ", "code_information": [ { "code": "0054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 99581.3,"maximum": 8.0827e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.0827e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 99581.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.69781e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.69781e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.69781e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.0827e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.69781e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.69781e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "006", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12306.8,"maximum": 75247.6,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 41879.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 55049.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 43136.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 41879.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 41879.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 41879.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 41879.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 41879.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 59261.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 50255.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 41879.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 63948.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 12306.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 60806.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 43554.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 54443.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 43973.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 41879.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 43973.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 56108, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 60806.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 75247.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 41879.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 64913.6, "methodology": "case rate" }]}]} , { "description": "PANCREAS TRANSPLANT ", "code_information": [ { "code": "0061", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 60029.5,"maximum": 3.81831e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.63649e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.63649e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.81831e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.81831e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.63649e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 60029.5, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.63649e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.63649e+008, "methodology": "case rate" }]}]} , { "description": "PANCREAS TRANSPLANT ", "code_information": [ { "code": "0062", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 84402.9,"maximum": 5.10558e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.86245e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 84402.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.86245e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.10558e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.86245e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.86245e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.86245e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.10558e+008, "methodology": "case rate" }]}]} , { "description": "PANCREAS TRANSPLANT ", "code_information": [ { "code": "0063", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 94371.5,"maximum": 6.37643e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.07279e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.07279e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.07279e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 94371.5, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.07279e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.37643e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.07279e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.37643e+008, "methodology": "case rate" }]}]} , { "description": "PANCREAS TRANSPLANT ", "code_information": [ { "code": "0064", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 149325,"maximum": 8.97568e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.54826e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.54826e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.97568e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 149325, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.54826e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.54826e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.97568e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.54826e+008, "methodology": "case rate" }]}]} , { "description": "Vaccine administration", "code_information": [ { "code": "0064A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.54,"maximum": 40,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7.54, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 40, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40, "methodology": "fee schedule" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "007", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13337.5,"maximum": 190828,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 190828, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 132591, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 105695, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 105695, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 120038, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 163827, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 109922, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 105695, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 162174, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 137403, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 105695, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 110979, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 105695, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 132591, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 110979, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 105695, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 142290, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 105695, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 13337.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 105695, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 105695, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 126834, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 108866, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 150288, "methodology": "case rate" }]}]} , { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "0071", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4.97483e+008,"maximum": 5.22357e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.97483e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.97483e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.97483e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.22357e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.97483e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.97483e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.22357e+008, "methodology": "case rate" }]}]} , { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "0072", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5.23666e+008,"maximum": 5.4985e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.23666e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.23666e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.23666e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.4985e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.23666e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.23666e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.4985e+008, "methodology": "case rate" }]}]} , { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "0073", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6.53038e+008,"maximum": 6.8569e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.53038e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.8569e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.53038e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.8569e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.53038e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.53038e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.53038e+008, "methodology": "case rate" }]}]} , { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "0074", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.33618e+009,"maximum": 1.40299e+009,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.33618e+009, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.33618e+009, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.40299e+009, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.33618e+009, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.40299e+009, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.33618e+009, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.33618e+009, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "008", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12498.4,"maximum": 81856.3,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 46894.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 64466.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 81856.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 59357.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 54634.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 45528.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 65565.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 47804.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 45528.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 45528.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 45528.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 59187.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 47349.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 69564.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 12498.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 70569.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 45528.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 61035.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 47804.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 45528.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 45528.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 45528.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 45528.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 65565.1, "methodology": "case rate" }]}]} , { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY", "code_information": [ { "code": "0081", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.99691e+008,"maximum": 2.09675e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.09675e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.99691e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.99691e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.99691e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.09675e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.99691e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.99691e+008, "methodology": "case rate" }]}]} , { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY", "code_information": [ { "code": "0082", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 2.84677e+008,"maximum": 2.98911e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.84677e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.98911e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.84677e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.84677e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.84677e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.84677e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.98911e+008, "methodology": "case rate" }]}]} , { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY", "code_information": [ { "code": "0083", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3.37911e+008,"maximum": 3.54807e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.54807e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.37911e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.37911e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.37911e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.37911e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.54807e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.37911e+008, "methodology": "case rate" }]}]} , { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY", "code_information": [ { "code": "0084", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6.62267e+008,"maximum": 6.9538e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.62267e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.62267e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.9538e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.62267e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.62267e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.62267e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.9538e+008, "methodology": "case rate" }]}]} , { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)", "code_information": [ { "code": "0091", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3.28391e+008,"maximum": 3.4481e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.28391e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.28391e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.4481e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.28391e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.28391e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.4481e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.28391e+008, "methodology": "case rate" }]}]} , { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)", "code_information": [ { "code": "0092", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3.45666e+008,"maximum": 3.62949e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.45666e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.45666e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.45666e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.62949e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.45666e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.45666e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.62949e+008, "methodology": "case rate" }]}]} , { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)", "code_information": [ { "code": "0093", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5.72961e+008,"maximum": 6.01609e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.01609e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.01609e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.72961e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.72961e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.72961e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.72961e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.72961e+008, "methodology": "case rate" }]}]} , { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)", "code_information": [ { "code": "0094", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.32948e+009,"maximum": 1.39596e+009,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.39596e+009, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.32948e+009, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.32948e+009, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.32948e+009, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.32948e+009, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.32948e+009, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.39596e+009, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "010", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10898.2,"maximum": 74885.2,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 55837.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 41679.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 42930, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 54183.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 41679.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 58976.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 41679.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 41679.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 41679.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 64603.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 43763.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 41679.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 56444.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 43763.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 41679.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 63640.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 56444.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 50015.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 10898.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 41679.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 51100.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 43346.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 41679.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 74885.2, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "011", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8585.71,"maximum": 80216.6,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 44623.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 46854.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 61388.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 68171.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 44623.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 61388.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 44623.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 69165.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 44623.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 63175, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 58010.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 44623.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 45961.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 55576.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 44623.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 46408.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 44623.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 59813.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 44623.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 46854.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 44623.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 53547.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 80216.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8585.71, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "0111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3.0569e+008,"maximum": 3.20974e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.0569e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.0569e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.20974e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.20974e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.0569e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.0569e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.0569e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "0112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6.70372e+008,"maximum": 7.03891e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.70372e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.70372e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.03891e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.03891e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.70372e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.70372e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.70372e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "0113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7.80745e+008,"maximum": 8.19783e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.80745e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.19783e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.80745e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.80745e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.80745e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.19783e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.80745e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "0114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.33872e+009,"maximum": 1.40566e+009,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.33872e+009, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.40566e+009, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.33872e+009, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.33872e+009, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.33872e+009, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.33872e+009, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.40566e+009, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "012", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9051.42,"maximum": 62304.2,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 34733.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 35775.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 43235.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 45153.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 41680, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 36470, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 47756.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 47756.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 34733.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 34733.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 52948.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 9051.42, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 36122.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 62304.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 34733.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 36470, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 49068, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 34733.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 53836.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 34733.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 34733.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 34733.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 46456.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 34733.3, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "013", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8594.5,"maximum": 41781.4,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 32905.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 26529.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 23402.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 36273.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 24338.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 29303.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 23402.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 24104.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 23402.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 23402.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 23402.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 30422.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 24572.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 24572.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8594.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 23402.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 23402.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 29303.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 31154.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 28082.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 23402.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 35507.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 23402.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 41781.4, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8470.1,"maximum": 178297,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 118531, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8470.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 98775.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 98775.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 153103, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 98775.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 103715, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 148713, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 128409, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 98775.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 132946, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 148713, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 101739, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 98775.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 98775.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 103715, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 98775.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 98775.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 98775.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 134633, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 151525, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 140419, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 102727, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 178297, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7128.28,"maximum": 96095.6,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 64068.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 96095.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 75680.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 54992.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 69407.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 81576, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 55526, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 73852.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 56059.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 56059.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 81666.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 81576, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 82755.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 71653.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7128.28, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11642.4,"maximum": 96095.6,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 56059.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 54796.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 71653.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 11642.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 55526, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 56059.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 64068.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 81666.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 53390.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 49608.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 69407.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 96095.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 54796.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 82755.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 54992.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 75680.6, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 47819.8,"maximum": 573162,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 491025, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 316790, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 332630, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 316790, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 316790, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 316790, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 332630, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 411827, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 326294, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 427375, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 316790, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 451397, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 316790, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 380148, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 47819.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 316790, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 329462, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 573162, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 316790, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 487097, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 316790, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "019", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12847.6,"maximum": 124355,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 68993, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 12847.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 106939, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 68993, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 68993, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 68993, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 71752.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 68993, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 124355, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 105682, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 68993, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 89690.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 92724.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 97936.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 68993, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 72442.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 82791.6, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 72442.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 71062.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 68993, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 68993, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "020", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16909.4,"maximum": 131494,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 72934.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 94815.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 72934.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 113049, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 75852.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 16909.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 87521.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 72934.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 76581.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 129791, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 72934.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 72934.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 117503, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 98047.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 72934.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 72934.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 72934.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 75122.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 111749, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 103559, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 76581.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 131494, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 72934.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 129791, "methodology": "case rate" }]}]} , { "description": "OPEN CRANIOTOMY FOR TRAUMA", "code_information": [ { "code": "0201", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 19342.6,"maximum": 1.55907e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.48483e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.48483e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.48483e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.55907e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.48483e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.55907e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 19342.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.48483e+008, "methodology": "case rate" }]}]} , { "description": "OPEN CRANIOTOMY FOR TRAUMA", "code_information": [ { "code": "0202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 26834.7,"maximum": 1.80111e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.71535e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.80111e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.80111e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 26834.7, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.71535e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.71535e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.71535e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.71535e+008, "methodology": "case rate" }]}]} , { "description": "Nfct ds 22 trgt sars-cov-2", "code_information": [ { "code": "0202U", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2083.9, "discounted_cash": 541,"minimum": 18.16,"maximum": 1667.12,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.78, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.78, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.78, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 437.62, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 429.28, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 989.61, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 583.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 416.78, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 850.23, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 833.56, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 287.29, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 416.78, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 625.17, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.78, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1146.14, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 458.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 333.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 416.78, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 500.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1146.14, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.78, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 625.17, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 646.01, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 416.78, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1146.14, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 416.78, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 433.45, "methodology": "fee schedule" }]}]} , { "description": "OPEN CRANIOTOMY FOR TRAUMA", "code_information": [ { "code": "0203", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 35211.9,"maximum": 2.57647e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.45378e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 35211.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.57647e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.45378e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.57647e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.45378e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.45378e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.45378e+008, "methodology": "case rate" }]}]} , { "description": "OPEN CRANIOTOMY FOR TRAUMA", "code_information": [ { "code": "0204", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 67081.6,"maximum": 4.1361e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.93914e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.93914e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 67081.6, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.93914e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.1361e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.1361e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.93914e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.93914e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "021", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16300.8,"maximum": 98527.4,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 63701.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 55208, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 55738.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 53084.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 53084.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 81195.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 16300.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 53084.6, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 53084.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 55738.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 53084.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 71240.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 54677.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 53084.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 98527.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 95541.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 69010, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 89199.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 82281.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 53084.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 53084.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 75244.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 98527.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 53084.6, "methodology": "case rate" }]}]} , { "description": "OPEN CRANIOTOMY EXCEPT TRAUMA", "code_information": [ { "code": "0211", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21352,"maximum": 1.46441e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.46441e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.39468e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.46441e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 21352, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.39468e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.39468e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.39468e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.39468e+008, "methodology": "case rate" }]}]} , { "description": "OPEN CRANIOTOMY EXCEPT TRAUMA", "code_information": [ { "code": "0212", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 27973.2,"maximum": 1.88922e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.79926e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.79926e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.79926e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.79926e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.79926e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 27973.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.88922e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.88922e+008, "methodology": "case rate" }]}]} , { "description": "OPEN CRANIOTOMY EXCEPT TRAUMA", "code_information": [ { "code": "0213", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 42869.1,"maximum": 2.85283e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.85283e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.71698e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.71698e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.71698e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.85283e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.71698e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.71698e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 42869.1, "methodology": "case rate" }]}]} , { "description": "OPEN CRANIOTOMY EXCEPT TRAUMA", "code_information": [ { "code": "0214", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 74949.8,"maximum": 4.61669e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.39685e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.39685e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.61669e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.39685e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.61669e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 74949.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.39685e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.39685e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "022", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 26488.8,"maximum": 64429.8,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 42596.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 64429.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 40329.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 34027.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 35728.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 58330, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 34027.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 34027.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 34027.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 34027.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 35388.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 54087, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 64429.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 40832.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 34027.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 35048.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 52742.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 34027.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 35728.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 26488.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 45965.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 34027.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 44235.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 34027.3, "methodology": "case rate" }]}]} , { "description": "VENTRICULAR SHUNT PROCEDURES ", "code_information": [ { "code": "0221", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12844,"maximum": 9.64296e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12844, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.18377e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.64296e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.64296e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.18377e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.18377e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.18377e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.18377e+007, "methodology": "case rate" }]}]} , { "description": "VENTRICULAR SHUNT PROCEDURES ", "code_information": [ { "code": "0222", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16324,"maximum": 1.18025e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.18025e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.18025e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.12405e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.12405e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.12405e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16324, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.12405e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.12405e+008, "methodology": "case rate" }]}]} , { "description": "VENTRICULAR SHUNT PROCEDURES ", "code_information": [ { "code": "0223", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 27680.5,"maximum": 1.82121e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 27680.5, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.73448e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.73448e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.73448e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.82121e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.73448e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.82121e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.73448e+008, "methodology": "case rate" }]}]} , { "description": "VENTRICULAR SHUNT PROCEDURES ", "code_information": [ { "code": "0224", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 65639.9,"maximum": 3.57758e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.40722e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.57758e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.57758e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 65639.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.40722e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.40722e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.40722e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.40722e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 35500.6,"maximum": 88189.5,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 49025.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 49025.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 49025.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 49025.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 63732.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 49025.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 35500.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 49025.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 49025.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 51476.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 50986.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 74947.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 61729.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 69454.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 50496, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 68184.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 58830.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 88189.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 49025.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 68184.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 51476.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 75989.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 65758.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 49025.3, "methodology": "case rate" }]}]} , { "description": "SPINAL PROCEDURES ", "code_information": [ { "code": "0231", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14505.5,"maximum": 1.25844e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.19851e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.25844e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 14505.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.25844e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.19851e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.19851e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.19851e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.19851e+008, "methodology": "case rate" }]}]} , { "description": "SPINAL PROCEDURES ", "code_information": [ { "code": "0232", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20783.4,"maximum": 1.61854e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20783.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.54146e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.61854e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.54146e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.54146e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.54146e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.54146e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.61854e+008, "methodology": "case rate" }]}]} , { "description": "SPINAL PROCEDURES ", "code_information": [ { "code": "0233", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 40154.9,"maximum": 2.68473e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.55688e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.55688e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.68473e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.68473e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 40154.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.55688e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.55688e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.55688e+008, "methodology": "case rate" }]}]} , { "description": "SPINAL PROCEDURES ", "code_information": [ { "code": "0234", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 71718.2,"maximum": 4.23862e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 71718.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.23862e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.03678e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.23862e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.03678e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.03678e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.03678e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.03678e+008, "methodology": "case rate" }]}]} , { "description": "Trluml perip athrc renal art", "code_information": [ { "code": "0234T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11638, "discounted_cash": 14120,"minimum": 18.16,"maximum": 11638,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 8689.34, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9310.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11404.8, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 4060.59, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11187.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11296.1, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3217.46, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3491.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6400.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9310.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11638, "methodology": "fee schedule" }]}]} , { "description": "Trluml perip athrc visceral", "code_information": [ { "code": "0235T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11638,"minimum": 18.16,"maximum": 9310.4,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 6400.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6400.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9310.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 6400.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3491.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9310.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Trluml perip athrc abd aorta", "code_information": [ { "code": "0236T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11638, "discounted_cash": 14120,"minimum": 18.16,"maximum": 11638,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3491.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11187.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9310.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11404.8, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9310.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 4060.59, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 8689.34, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3217.46, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11296.1, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6400.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Trluml perip athrc brchiocph", "code_information": [ { "code": "0237T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11638, "discounted_cash": 14120,"minimum": 18.16,"maximum": 11638,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11404.8, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9310.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11296.1, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11187.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 8689.34, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9310.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 4060.59, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6400.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 10861.7, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3217.46, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3491.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Trluml perip athrc iliac art", "code_information": [ { "code": "0238T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11638, "discounted_cash": 22506,"minimum": 18.16,"maximum": 11638,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9310.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3491.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9310.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6400.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3217.46, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 4060.59, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11638, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 11638, "methodology": "fee schedule" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 28564.5,"maximum": 58942.4,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 39452.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 32877.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 49067.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 42740.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 32877.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 32877.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 32877.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 32877.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 44422.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 34192.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 28564.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 46420.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 32877.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 33863.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 43950.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 50091.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 49067.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 34521.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 50959.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 32877.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 32877.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 58942.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 32877.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 34521.1, "methodology": "case rate" }]}]} , { "description": "OPEN EXTRACRANIAL VASCULAR PROCEDURES", "code_information": [ { "code": "0241", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11619.4,"maximum": 6.82195e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.4971e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11619.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.82195e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.4971e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.4971e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.4971e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.4971e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.82195e+007, "methodology": "case rate" }]}]} , { "description": "Nfct ds vir resp rna 4 trgt ", "code_information": [ { "code": "0241U", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 713.15, "discounted_cash": 185,"minimum": 18.16,"maximum": 570.52,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 142.63, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 156.89, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 142.63, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 338.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 142.63, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 142.63, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 142.63, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 146.91, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 114.1, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 142.63, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 142.63, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 59.95, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 98.31, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 142.63, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 149.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 59.95, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 213.94, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 199.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 290.97, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 221.08, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 142.63, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 213.94, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 142.63, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 51.31, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 148.34, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 171.16, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 285.26, "methodology": "fee schedule" }]}]} , { "description": "OPEN EXTRACRANIAL VASCULAR PROCEDURES", "code_information": [ { "code": "0242", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15330,"maximum": 9.17622e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.73926e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.73926e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.17622e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.73926e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.73926e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15330, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.17622e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.73926e+007, "methodology": "case rate" }]}]} , { "description": "OPEN EXTRACRANIAL VASCULAR PROCEDURES", "code_information": [ { "code": "0243", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 29993.5,"maximum": 1.65304e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 29993.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.57433e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.57433e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.57433e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.57433e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.65304e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.57433e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.65304e+008, "methodology": "case rate" }]}]} , { "description": "OPEN EXTRACRANIAL VASCULAR PROCEDURES", "code_information": [ { "code": "0244", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 63666,"maximum": 3.01007e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.86673e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.86673e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 63666, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.01007e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.86673e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.86673e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.01007e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.86673e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13379.3,"maximum": 68699.7,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 48444.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 38264.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 59309.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 38264.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 45917.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 38264.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 68699.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 38264.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 39795, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 38264.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 40177.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 38264.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 40177.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 39412.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 53511.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 38264.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 49743.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 38264.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 13379.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 51225.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 54104.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 53511.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 38264.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 58383.9, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16333.6,"maximum": 45941.4,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 16333.6, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 33408.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 25699, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 25699, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 25699, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 25699, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 34271.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 25699, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 37855.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 34256, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 25699, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 39833.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 26984, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 30838.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 45941.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 36181.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 26727, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 26470, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 25699, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 26984, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 39042.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 25699, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 37855.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 25699, "methodology": "case rate" }]}]} , { "description": "OTHER NERVOUS SYSTEM & RELATED PROCEDURES ", "code_information": [ { "code": "0261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13306.3,"maximum": 9.85012e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.85012e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.38106e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.38106e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.85012e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.38106e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.38106e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 13306.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.38106e+007, "methodology": "case rate" }]}]} , { "description": "OTHER NERVOUS SYSTEM & RELATED PROCEDURES ", "code_information": [ { "code": "0262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 17565.6,"maximum": 1.26087e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.20083e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.20083e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.20083e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.26087e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.26087e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.20083e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 17565.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.20083e+008, "methodology": "case rate" }]}]} , { "description": "OTHER NERVOUS SYSTEM & RELATED PROCEDURES ", "code_information": [ { "code": "0263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 25173.2,"maximum": 1.88048e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.79094e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.79094e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.79094e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.79094e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 25173.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.88048e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.88048e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.79094e+008, "methodology": "case rate" }]}]} , { "description": "OTHER NERVOUS SYSTEM & RELATED PROCEDURES ", "code_information": [ { "code": "0264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 53013.6,"maximum": 3.51169e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.51169e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.34446e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.34446e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.34446e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.51169e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.34446e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.34446e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 53013.6, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21230.8,"maximum": 37848.6,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 29807.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 22080, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 30286.4, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 22292.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 21230.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 21230.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 21867.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 21230.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 30286.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 25477, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 21230.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 32907.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 37848.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 22292.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 21230.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 28221.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 27419, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 21230.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 32165.4, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 27600, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 21230.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 21230.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 26961.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 21230.8, "methodology": "case rate" }]}]} , { "description": "OTHER OPEN CRANIOTOMY", "code_information": [ { "code": "0271", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.25812e+008,"maximum": 1.32102e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.25812e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.25812e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.25812e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.25812e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.25812e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.32102e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.32102e+008, "methodology": "case rate" }]}]} , { "description": "OTHER OPEN CRANIOTOMY", "code_information": [ { "code": "0272", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.42297e+008,"maximum": 1.49412e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.42297e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.42297e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.49412e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.49412e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.42297e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.42297e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.42297e+008, "methodology": "case rate" }]}]} , { "description": "OTHER OPEN CRANIOTOMY", "code_information": [ { "code": "0273", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 2.35834e+008,"maximum": 2.47626e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.35834e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.47626e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.35834e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.35834e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.47626e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.35834e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.35834e+008, "methodology": "case rate" }]}]} , { "description": "OTHER OPEN CRANIOTOMY", "code_information": [ { "code": "0274", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4.12141e+008,"maximum": 4.32748e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.12141e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.12141e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.32748e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.32748e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.12141e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.12141e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.12141e+008, "methodology": "case rate" }]}]} , { "description": "Perq lamot/lam lumbar", "code_information": [ { "code": "0275T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26107.8, "discounted_cash": 9182,"minimum": 18.16,"maximum": 20886.3,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 14359.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16771.3, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 20886.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10948.2, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14409.2, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7832.35, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 14359.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 14359.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20886.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14126.7, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10595, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "028", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 34408.3,"maximum": 93748,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 34408.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 79671.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 52094.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 52094.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 52094.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 69902.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 52094.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 67126, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 53657.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 52094.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 73831.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 54698.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 62513.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 60770.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 67722.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 54178, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 67126, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 54698.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 52094.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 52094.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 52094.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 52094.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 80746.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 93748, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "029", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23398.6,"maximum": 53332.5,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 29779.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 35735.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 46158.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 29779.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 53332.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 29779.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 39592.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 30971, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 29779.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 30673.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 29779.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 29779.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 39592.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 42002.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 23398.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 45324.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 31268.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 39767.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 29779.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 29779.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 31268.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 38713.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 29779.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 35843.8, "methodology": "case rate" }]}]} , { "description": "OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES", "code_information": [ { "code": "0291", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.48846e+008,"maximum": 1.56288e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.48846e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.56288e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.48846e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.48846e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.48846e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.56288e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.48846e+008, "methodology": "case rate" }]}]} , { "description": "OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES", "code_information": [ { "code": "0292", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.68106e+008,"maximum": 1.76511e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.68106e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.76511e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.68106e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.68106e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.68106e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.76511e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.68106e+008, "methodology": "case rate" }]}]} , { "description": "OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES", "code_information": [ { "code": "0293", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.89125e+008,"maximum": 1.98581e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.89125e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.89125e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.89125e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.98581e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.98581e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.89125e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.89125e+008, "methodology": "case rate" }]}]} , { "description": "OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES", "code_information": [ { "code": "0294", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 2.89252e+008,"maximum": 3.03715e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.89252e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.89252e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.89252e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.03715e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.89252e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.03715e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.89252e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "030", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 19814.7,"maximum": 36076.7,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 20252.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 26328.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 24835.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 20252.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 20252.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 27432.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 20252.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 30659.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 36076.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 21265.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 20252.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 26900.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 20252.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 24303, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 27432.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 21062.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 20252.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 31391.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 19814.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 20860.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 20252.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 20252.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 21265.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 28412.4, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES", "code_information": [ { "code": "0301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.28789e+008,"maximum": 1.35229e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.35229e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.28789e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.28789e+008, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 98.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 67.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.35229e+008, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 98.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 67.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.28789e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 12.3, "standard_charge_percentage": 10.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 36.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.28789e+008, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 67.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.28789e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES", "code_information": [ { "code": "0302", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.77804e+008,"maximum": 1.86694e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.86694e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.77804e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.77804e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.77804e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.77804e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.77804e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.86694e+008, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES", "code_information": [ { "code": "0303", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 2.4145e+008,"maximum": 2.53522e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.4145e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.4145e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.4145e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.4145e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.53522e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.4145e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.53522e+008, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES", "code_information": [ { "code": "0304", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3.24231e+008,"maximum": 3.40442e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.24231e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.24231e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.40442e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.24231e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.40442e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.24231e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.24231e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "031", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11615.3,"maximum": 64041.9,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 36763.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 47382.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 55323.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 37120.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 46400.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 52337.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 42831.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 64041.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 35692.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 11615.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 47752.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 37477.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 35692.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 50436.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 35692.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 35692.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 35692.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 35692.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 54425.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 35692.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 37477.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 35692.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 52337.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 35692.8, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "032", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14798.5,"maximum": 33506.7,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 28475.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 18833.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 24483.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 14798.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 29001, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 29191.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 19398.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 19586.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 19775.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 29001, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 18833.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 26255.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 18833.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 18833.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 18833.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 18833.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 24984.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 22600.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 19775.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 18833.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 18833.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 26388.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 33506.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 18833.5, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "033", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14273.4,"maximum": 25247.5,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 14987.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 14273.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 14273.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14844.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 14273.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 19883.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 14273.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 21377.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 18825.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 19353.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 14273.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 14273.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 14273.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14987.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 25247.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 18555.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 14273.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 17128.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 14273.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 21377.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 14701.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 20645.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 22123.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 21456.4, "methodology": "case rate" }]}]} , { "description": "Heart symp image plnr", "code_information": [ { "code": "0331T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6833.64, "discounted_cash": 1822,"minimum": 18.16,"maximum": 5466.91,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1962.74, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3758.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5466.91, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1458.04, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 2803.92, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2050.09, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1542.16, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1121.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2173.04, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3328.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2860, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5466.91, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3758.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 825.29, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1444.02, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3758.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1472.06, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1682.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2102.94, "methodology": "fee schedule" }]}]} , { "description": "HEART SYMP IMAGE PLNR SPECT", "code_information": [ { "code": "0332T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6833.64, "discounted_cash": 1822,"minimum": 18.16,"maximum": 5466.91,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3758.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2050.09, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5466.91, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 2803.92, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1962.74, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3758.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1472.06, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1542.16, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1682.35, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1121.57, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3758.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2173.04, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3328.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2102.94, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1458.04, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5466.91, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2860, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 825.29, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1401.96, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1444.02, "methodology": "fee schedule" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15251,"maximum": 60694.1,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 33844.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 35536.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 45102.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 33844.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 51580.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 33844.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40832.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 15251, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 33844.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 52458.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 45102.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 47799.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 35198.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 33844.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 33844.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 33844.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 40613.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 33844.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 60694.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 34859.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 33844.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 45256.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 35536.6, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 43997.7, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20085,"maximum": 35773.3,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 20085, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 31131.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 28173.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 21089.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 26110.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 20085, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 20085, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 27986, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 20085, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 20085, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 20687.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 20888.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 26674.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 20085, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 20085, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 25336.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 20085, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 21089.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 20085, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 24102, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 27986, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 22207.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 30401.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 35773.3, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15865,"maximum": 30479.9,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 15865, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 21852.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 19038, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15865, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 15865, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 20624.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 23906.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 21852.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 16341, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 15865, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 15865, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 22154.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 19784, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 16499.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 24590.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 15865, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 20975.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 30479.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 15865, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 15865, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 16658.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 16658.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15865, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 28130.2, "methodology": "case rate" }]}]} , { "description": "Minor surgery", "code_information": [ { "code": "0361", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7,"minimum": 12.3,"maximum": 5264,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1593.18, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1593.18, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1593.18, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 289.67, "standard_charge_percentage": 10.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2896.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 869.01, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13119.6,"maximum": 52514.2,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 29328, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 52514.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 30207.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 30501.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 29328, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 30794.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 13119.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40263.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 29328, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40263.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 29328, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 39157, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 29328, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 29328, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 29328, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 29328, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 45458.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 36451.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 29328, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 35193.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 41357.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 44628.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 30794.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 38126.5, "methodology": "case rate" }]}]} , { "description": "Anesthesia", "code_information": [ { "code": "0370", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1950,"minimum": 12.3,"maximum": 5264,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 195, "standard_charge_percentage": 10.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 440, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 302.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 41.25, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5264, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1560, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 75.63, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3355, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 302.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 585, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 75.63, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 206.25, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3619, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4880, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 112.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1072.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 440, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3619, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 300, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 75.63, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 206.25, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1974, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 302.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 658, "standard_charge_percentage": 10.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1830, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4880, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3355, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5264, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 55, "standard_charge_percentage": 10.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 206.25, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 110, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 110, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 37.5, "standard_charge_percentage": 10.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 165, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 300, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3355, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1560, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3619, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1072.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 610, "standard_charge_percentage": 10.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1072.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 13.75, "standard_charge_percentage": 10.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14075.9,"maximum": 24889.6,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 14075.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14638.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 14075.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 21179.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 14498.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 24889.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 16740.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 14075.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 14075.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 21152.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 16891, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 18558.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 14075.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 21817.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 19602, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 14075.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 14075.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14779.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 14075.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 21179.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 14075.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 19174, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 14779.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 18298.6, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10134.2,"maximum": 18681.4,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10134.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 10438.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 14487.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 13979.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 10539.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 17750.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 18681.4, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 10640.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 15085.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 15708, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10134.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 13235.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10134.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10134.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 12161, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10134.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10134.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10134.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 13116.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10134.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10134.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 10640.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 13174.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 14487.7, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "040", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23681.8,"maximum": 59902.2,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 35077.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 33407.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 33407.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 49177.1, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 33407.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 43429.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 34409.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 59902.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 44665.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 33407.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 47176.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 49177.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 33407.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 33407.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 40088.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 33407.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 44521.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 51781.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 23681.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 35077.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 34743.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 50907.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 33407.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 33407.2, "methodology": "case rate" }]}]} , { "description": "SPINAL DISORDERS & INJURIES ", "code_information": [ { "code": "0401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10128.9,"maximum": 7.45155e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.09671e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.09671e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.45155e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.09671e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.09671e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10128.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.45155e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.09671e+007, "methodology": "case rate" }]}]} , { "description": "SPINAL DISORDERS & INJURIES ", "code_information": [ { "code": "0402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11492.3,"maximum": 1.00317e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.00317e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.554e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.554e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.00317e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11492.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.554e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.554e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.554e+007, "methodology": "case rate" }]}]} , { "description": "SPINAL DISORDERS & INJURIES ", "code_information": [ { "code": "0403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16402.9,"maximum": 1.42211e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.35439e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.35439e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.35439e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.35439e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.42211e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.35439e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16402.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.42211e+008, "methodology": "case rate" }]}]} , { "description": "SPINAL DISORDERS & INJURIES ", "code_information": [ { "code": "0404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 42415.7,"maximum": 2.01489e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.91894e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.01489e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.91894e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.01489e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.91894e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.91894e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.91894e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 42415.7, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "041", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 17197.5,"maximum": 34703,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 20468.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 19494, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 20273.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 19494, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 19494, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 27330.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 19494, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 34703, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 20468.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 17197.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 29699.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 19494, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 30215.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 19494, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 19494, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 23392.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 19494, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 29492.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 19494, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 20078.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 29699.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 26887.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 25876.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 25342.2, "methodology": "case rate" }]}]} , { "description": "NERVOUS SYSTEM MALIGNANCY ", "code_information": [ { "code": "0411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7828.15,"maximum": 6.20734e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.20734e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7828.15, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.20734e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.91175e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.91175e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.91175e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.91175e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.91175e+007, "methodology": "case rate" }]}]} , { "description": "NERVOUS SYSTEM MALIGNANCY ", "code_information": [ { "code": "0412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8697.94,"maximum": 6.37207e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.06864e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.37207e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.06864e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.06864e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.37207e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.06864e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.06864e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8697.94, "methodology": "case rate" }]}]} , { "description": "NERVOUS SYSTEM MALIGNANCY ", "code_information": [ { "code": "0413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11880.4,"maximum": 8.72259e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.30723e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.72259e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.30723e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11880.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.72259e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.30723e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.30723e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.30723e+007, "methodology": "case rate" }]}]} , { "description": "NERVOUS SYSTEM MALIGNANCY ", "code_information": [ { "code": "0414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21111.7,"maximum": 1.34917e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.28492e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.28492e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.28492e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.34917e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 21111.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.34917e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.28492e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.28492e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "042", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15277.5,"maximum": 27066.1,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15277.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 16041.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 15888.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 15277.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 23658.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 18333, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 20181.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 15277.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 16487.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 15277.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 15277.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15277.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 23680.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 15277.5, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 15735.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 21418.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 15277.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 15277.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 23001.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 16041.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 23658.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 27066.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 19860.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 21316, "methodology": "case rate" }]}]} , { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS ", "code_information": [ { "code": "0421", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6163.4,"maximum": 5.03862e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.79869e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.79869e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.79869e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.79869e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.03862e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.79869e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6163.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.03862e+007, "methodology": "case rate" }]}]} , { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS ", "code_information": [ { "code": "0422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7671.13,"maximum": 6.3521e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.3521e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.3521e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.04962e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.04962e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7671.13, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.04962e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.04962e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.04962e+007, "methodology": "case rate" }]}]} , { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS ", "code_information": [ { "code": "0423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11961.6,"maximum": 9.4202e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.4202e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.97162e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.97162e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11961.6, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.97162e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.4202e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.97162e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.97162e+007, "methodology": "case rate" }]}]} , { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS ", "code_information": [ { "code": "0424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 32167.5,"maximum": 1.79275e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.70738e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.70738e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.70738e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 32167.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.79275e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.70738e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.70738e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.79275e+008, "methodology": "case rate" }]}]} , { "description": "MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES", "code_information": [ { "code": "0431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8096.19,"maximum": 6.52556e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.52556e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8096.19, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.21482e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.21482e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.21482e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.21482e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.52556e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.21482e+007, "methodology": "case rate" }]}]} , { "description": "MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES", "code_information": [ { "code": "0432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10375,"maximum": 9.03583e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.60555e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.60555e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10375, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.03583e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.60555e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.60555e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.03583e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.60555e+007, "methodology": "case rate" }]}]} , { "description": "MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES", "code_information": [ { "code": "0433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16583.2,"maximum": 1.3335e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.3335e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.3335e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.27e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.27e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.27e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.27e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.27e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16583.2, "methodology": "case rate" }]}]} , { "description": "MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES", "code_information": [ { "code": "0434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 37004.8,"maximum": 2.54078e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.54078e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.41979e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.41979e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.41979e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.41979e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.54078e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.41979e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 37004.8, "methodology": "case rate" }]}]} , { "description": "INTRACRANIAL HEMORRHAGE ", "code_information": [ { "code": "0441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8796.08,"maximum": 6.18987e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8796.08, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.89511e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.89511e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.18987e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.89511e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.89511e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.18987e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.89511e+007, "methodology": "case rate" }]}]} , { "description": "INTRACRANIAL HEMORRHAGE ", "code_information": [ { "code": "0442", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11326.2,"maximum": 8.29953e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.90432e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.29953e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.29953e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.90432e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.90432e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.90432e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11326.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.90432e+007, "methodology": "case rate" }]}]} , { "description": "INTRACRANIAL HEMORRHAGE ", "code_information": [ { "code": "0443", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16725.5,"maximum": 1.17888e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.12275e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16725.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.12275e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.12275e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.12275e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.12275e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.17888e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.17888e+008, "methodology": "case rate" }]}]} , { "description": "INTRACRANIAL HEMORRHAGE ", "code_information": [ { "code": "0444", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 34766.1,"maximum": 1.50148e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.50148e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.50148e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.42998e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 34766.1, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.42998e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.42998e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.42998e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.42998e+008, "methodology": "case rate" }]}]} , { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT ", "code_information": [ { "code": "0451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7560.05,"maximum": 5.40739e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.1499e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.40739e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7560.05, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.1499e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.40739e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.1499e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.1499e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.1499e+007, "methodology": "case rate" }]}]} , { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT ", "code_information": [ { "code": "0452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9175.91,"maximum": 6.96672e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.96672e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.63497e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9175.91, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.96672e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.63497e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.63497e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.63497e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.63497e+007, "methodology": "case rate" }]}]} , { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT ", "code_information": [ { "code": "0453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13230.7,"maximum": 9.87009e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.40009e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.40009e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.87009e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 13230.7, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.40009e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.40009e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.40009e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.87009e+007, "methodology": "case rate" }]}]} , { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT ", "code_information": [ { "code": "0454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 27541.1,"maximum": 1.64761e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.56916e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.56916e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.56916e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.56916e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 27541.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.56916e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.64761e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.64761e+008, "methodology": "case rate" }]}]} , { "description": "NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT ", "code_information": [ { "code": "0461", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7405.65,"maximum": 5.52595e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.26281e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.26281e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.26281e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.26281e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.52595e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.52595e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.26281e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7405.65, "methodology": "case rate" }]}]} , { "description": "NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT ", "code_information": [ { "code": "0462", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8450.27,"maximum": 6.34274e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.34274e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.0407e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8450.27, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.0407e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.0407e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.34274e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.0407e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.0407e+007, "methodology": "case rate" }]}]} , { "description": "NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT ", "code_information": [ { "code": "0463", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11766.5,"maximum": 8.23028e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.83836e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.83836e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.83836e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.83836e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.23028e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11766.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.23028e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.83836e+007, "methodology": "case rate" }]}]} , { "description": "NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT ", "code_information": [ { "code": "0464", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 29221.9,"maximum": 1.63801e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.56e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.56e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.56e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.63801e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 29221.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.63801e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.56e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.56e+008, "methodology": "case rate" }]}]} , { "description": "TRANSIENT ISCHEMIA ", "code_information": [ { "code": "0471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6185.12,"maximum": 5.07107e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.07107e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.07107e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.82959e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.82959e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6185.12, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.82959e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.82959e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.82959e+007, "methodology": "case rate" }]}]} , { "description": "TRANSIENT ISCHEMIA ", "code_information": [ { "code": "0472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6714.28,"maximum": 5.68194e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.68194e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.41138e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.41138e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.41138e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.41138e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.41138e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6714.28, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.68194e+007, "methodology": "case rate" }]}]} , { "description": "TRANSIENT ISCHEMIA ", "code_information": [ { "code": "0473", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8385.95,"maximum": 7.17637e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.83464e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.83464e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.17637e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8385.95, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.83464e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.83464e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.83464e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.17637e+007, "methodology": "case rate" }]}]} , { "description": "TRANSIENT ISCHEMIA ", "code_information": [ { "code": "0474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16669.5,"maximum": 1.3043e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.24219e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16669.5, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.24219e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.24219e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.24219e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.24219e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.3043e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.3043e+008, "methodology": "case rate" }]}]} , { "description": "PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS ", "code_information": [ { "code": "0481", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6243.1,"maximum": 4.98559e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.74818e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.74818e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.98559e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6243.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.74818e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.98559e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.74818e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.74818e+007, "methodology": "case rate" }]}]} , { "description": "PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS ", "code_information": [ { "code": "0482", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7008.91,"maximum": 5.61144e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.34423e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.61144e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.34423e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7008.91, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.34423e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.61144e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.34423e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.34423e+007, "methodology": "case rate" }]}]} , { "description": "PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS ", "code_information": [ { "code": "0483", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9778.11,"maximum": 7.80223e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.43069e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.80223e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.43069e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9778.11, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.43069e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.43069e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.80223e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.43069e+007, "methodology": "case rate" }]}]} , { "description": "PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS ", "code_information": [ { "code": "0484", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 24235.5,"maximum": 1.53705e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 24235.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.46385e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.46385e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.53705e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.46385e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.46385e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.53705e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.46385e+008, "methodology": "case rate" }]}]} , { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM ", "code_information": [ { "code": "0491", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9439.66,"maximum": 6.9168e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.9168e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.58743e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.58743e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.9168e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.58743e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9439.66, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.58743e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.58743e+007, "methodology": "case rate" }]}]} , { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM ", "code_information": [ { "code": "0492", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20636,"maximum": 1.44576e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.37691e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.37691e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20636, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.44576e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.44576e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.37691e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.37691e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.37691e+008, "methodology": "case rate" }]}]} , { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM ", "code_information": [ { "code": "0493", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 25591.2,"maximum": 1.64674e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.56833e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.64674e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.56833e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.56833e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.56833e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.64674e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 25591.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.56833e+008, "methodology": "case rate" }]}]} , { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM ", "code_information": [ { "code": "0494", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 47080.5,"maximum": 2.68024e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.68024e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.55261e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.55261e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.68024e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.55261e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 47080.5, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.55261e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.55261e+008, "methodology": "case rate" }]}]} , { "description": "NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS ", "code_information": [ { "code": "0501", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6647.72,"maximum": 5.11225e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.11225e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6647.72, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.86881e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.11225e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.86881e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.86881e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.86881e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.86881e+007, "methodology": "case rate" }]}]} , { "description": "NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS ", "code_information": [ { "code": "0502", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12404.6,"maximum": 9.74966e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.74966e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.28539e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12404.6, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.28539e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.28539e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.28539e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.74966e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.28539e+007, "methodology": "case rate" }]}]} , { "description": "NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS ", "code_information": [ { "code": "0503", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20475.5,"maximum": 1.56044e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.56044e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.48614e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.48614e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.48614e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.56044e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.48614e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.48614e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20475.5, "methodology": "case rate" }]}]} , { "description": "NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS ", "code_information": [ { "code": "0504", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 42329.4,"maximum": 3.03597e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.03597e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.8914e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 42329.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.8914e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.03597e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.8914e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.8914e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.8914e+008, "methodology": "case rate" }]}]} , { "description": "VIRAL MENINGITIS ", "code_information": [ { "code": "0511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5717.07,"maximum": 3.70144e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.70144e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.70144e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.52518e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.52518e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.52518e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.52518e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.52518e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5717.07, "methodology": "case rate" }]}]} , { "description": "VIRAL MENINGITIS ", "code_information": [ { "code": "0512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7889.2,"maximum": 5.21084e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.21084e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7889.2, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.96271e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.96271e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.96271e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.96271e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.21084e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.96271e+007, "methodology": "case rate" }]}]} , { "description": "VIRAL MENINGITIS ", "code_information": [ { "code": "0513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13827.5,"maximum": 9.29478e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 13827.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.85217e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.85217e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.85217e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.85217e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.29478e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.85217e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.29478e+007, "methodology": "case rate" }]}]} , { "description": "VIRAL MENINGITIS ", "code_information": [ { "code": "0514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 28197.2,"maximum": 1.78913e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.70394e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 28197.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.78913e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.70394e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.70394e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.78913e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.70394e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.70394e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "052", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8444.7,"maximum": 30250.6,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 22146.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8444.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 19496.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 21535.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 26405.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 17035.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 17035.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 17035.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 17035.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 20442.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 17546.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 30250.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 22556.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 17887.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 17887.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 17035.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 17717.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 23824, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 25708.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 17035.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 17035.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 21535.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 17035.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 17035.8, "methodology": "case rate" }]}]} , { "description": "ALTERATION IN CONSCIOUSNESS ", "code_information": [ { "code": "0521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5744.43,"maximum": 4.47954e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.47954e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.26623e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.26623e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.26623e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.26623e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.26623e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.47954e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5744.43, "methodology": "case rate" }]}]} , { "description": "ALTERATION IN CONSCIOUSNESS ", "code_information": [ { "code": "0522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6723.64,"maximum": 5.01117e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6723.64, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.77254e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.01117e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.01117e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.77254e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.77254e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.77254e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.77254e+007, "methodology": "case rate" }]}]} , { "description": "ALTERATION IN CONSCIOUSNESS ", "code_information": [ { "code": "0523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9060.86,"maximum": 6.83818e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.51255e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9060.86, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.51255e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.51255e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.83818e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.51255e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.83818e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.51255e+007, "methodology": "case rate" }]}]} , { "description": "ALTERATION IN CONSCIOUSNESS ", "code_information": [ { "code": "0524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23203.1,"maximum": 1.488e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.41714e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.488e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.41714e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 23203.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.41714e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.41714e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.488e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.41714e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "053", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7956.57,"maximum": 15305,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9135.27, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11419.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9223.11, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11779.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 13615.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8783.91, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8783.91, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7956.57, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8783.91, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10663.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11779.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9047.43, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10540.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 12053.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11412.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 9223.11, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8783.91, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8783.91, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8783.91, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 15305, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8783.91, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8783.91, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8783.91, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13006.8, "methodology": "case rate" }]}]} , { "description": "SEIZURE ", "code_information": [ { "code": "0531", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5376.45,"maximum": 4.02403e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.83241e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.83241e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5376.45, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.02403e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.83241e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.83241e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.83241e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.02403e+007, "methodology": "case rate" }]}]} , { "description": "SEIZURE ", "code_information": [ { "code": "0532", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6382.37,"maximum": 5.01616e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.7773e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.7773e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.01616e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6382.37, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.01616e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.7773e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.7773e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.7773e+007, "methodology": "case rate" }]}]} , { "description": "SEIZURE ", "code_information": [ { "code": "0533", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9544.47,"maximum": 7.18199e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9544.47, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.18199e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.83999e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.83999e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.83999e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.83999e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.18199e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.83999e+007, "methodology": "case rate" }]}]} , { "description": "SEIZURE ", "code_information": [ { "code": "0534", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 24022.4,"maximum": 1.60487e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.52845e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 24022.4, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.52845e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.52845e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.60487e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.52845e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.52845e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.60487e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "054", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7098.52,"maximum": 22923.2,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 12990.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 12990.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 13639.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 16773.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 15588.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 13509.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 17092.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 12990.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 12990.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 16887.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 16773.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 15185.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 22923.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7098.52, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 19481.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 12990.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 13639.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 12990.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 13379.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 12990.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 20134.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 12990.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 12990.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 18053.3, "methodology": "case rate" }]}]} , { "description": "MIGRAINE & OTHER HEADACHES ", "code_information": [ { "code": "0541", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5767.81,"maximum": 4.59747e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.37854e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.37854e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.37854e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.37854e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5767.81, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.59747e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.37854e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.59747e+007, "methodology": "case rate" }]}]} , { "description": "MIGRAINE & OTHER HEADACHES ", "code_information": [ { "code": "0542", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6648.43,"maximum": 5.41114e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.41114e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.15347e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.15347e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.15347e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.15347e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.15347e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6648.43, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.41114e+007, "methodology": "case rate" }]}]} , { "description": "MIGRAINE & OTHER HEADACHES ", "code_information": [ { "code": "0543", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8131.81,"maximum": 7.0809e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.0809e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.0809e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8131.81, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.74372e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.74372e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.74372e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.74372e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.74372e+007, "methodology": "case rate" }]}]} , { "description": "MIGRAINE & OTHER HEADACHES ", "code_information": [ { "code": "0544", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15365.8,"maximum": 1.16965e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.11395e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15365.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.16965e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.11395e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.11395e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.11395e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.11395e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.16965e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "055", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6761.87,"maximum": 16695.8,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 14188.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 10029.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 14805.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 12159, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9551.81, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9933.88, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9838.36, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9551.81, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9551.81, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6761.87, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 12417.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9551.81, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 13430.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11462.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 13430.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9551.81, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9551.81, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9551.81, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 13148.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9551.81, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9551.81, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 10029.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 12449.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 16695.8, "methodology": "case rate" }]}]} , { "description": "HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE ", "code_information": [ { "code": "0551", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6844.27,"maximum": 5.17403e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.17403e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.92765e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.92765e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.17403e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6844.27, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.92765e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.92765e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.92765e+007, "methodology": "case rate" }]}]} , { "description": "HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE ", "code_information": [ { "code": "0552", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9127.1,"maximum": 7.2681e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.2681e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.922e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.922e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9127.1, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.922e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.922e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.922e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.2681e+007, "methodology": "case rate" }]}]} , { "description": "HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE ", "code_information": [ { "code": "0553", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14593.5,"maximum": 1.11648e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.06332e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.06332e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.11648e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.06332e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.06332e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 14593.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.11648e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.06332e+008, "methodology": "case rate" }]}]} , { "description": "HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE ", "code_information": [ { "code": "0554", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 32849.1,"maximum": 2.05451e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.05451e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.95668e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.95668e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.95668e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.05451e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 32849.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.95668e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.95668e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7611.33,"maximum": 37243.5,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 20896.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 37243.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 20896.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 20896.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 26797.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 27770.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 29331.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 31651.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 32389.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 24260.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 21941.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 21941.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 20896.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 20896.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 20896.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 20896.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 26797.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 27165.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 20896.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 21732.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7611.33, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 25076, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 20896.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 21523.6, "methodology": "case rate" }]}]} , { "description": "BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA ", "code_information": [ { "code": "0561", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6879.12,"maximum": 5.21709e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.96865e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.96865e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.96865e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6879.12, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.96865e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.21709e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.21709e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.96865e+007, "methodology": "case rate" }]}]} , { "description": "BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA ", "code_information": [ { "code": "0562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9340.3,"maximum": 6.37144e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9340.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.37144e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.06804e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.06804e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.06804e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.06804e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.37144e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.06804e+007, "methodology": "case rate" }]}]} , { "description": "BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA ", "code_information": [ { "code": "0563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15454.7,"maximum": 1.01971e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.71148e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.01971e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.71148e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.01971e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.71148e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.71148e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15454.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.71148e+007, "methodology": "case rate" }]}]} , { "description": "BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA ", "code_information": [ { "code": "0564", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 37677.4,"maximum": 1.65229e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.65229e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.57361e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.57361e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 37677.4, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.57361e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.57361e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.57361e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.65229e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6660.94,"maximum": 21207.3,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 15436.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 12524.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 14451.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 12042.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 15813.1, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 12042.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 12042.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 12644.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 12644.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 12042.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 12404, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 12042.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 21207.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 15436.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 16701.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 12042.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 18022.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 13975.4, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 15655.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 12042.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 12042.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6660.94, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 18666.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 12042.8, "methodology": "case rate" }]}]} , { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA ", "code_information": [ { "code": "0571", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6779.5,"maximum": 4.85268e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.6216e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.6216e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.6216e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.85268e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.85268e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6779.5, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.6216e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.6216e+007, "methodology": "case rate" }]}]} , { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA ", "code_information": [ { "code": "0572", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8514.2,"maximum": 6.75519e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.43352e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.75519e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.43352e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8514.2, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.43352e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.43352e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.75519e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.43352e+007, "methodology": "case rate" }]}]} , { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA ", "code_information": [ { "code": "0573", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12016.7,"maximum": 9.96868e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.49398e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.49398e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.49398e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12016.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.96868e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.96868e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.49398e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.49398e+007, "methodology": "case rate" }]}]} , { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA ", "code_information": [ { "code": "0574", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 27529.6,"maximum": 1.5874e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.51181e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 27529.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.5874e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.51181e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.51181e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.51181e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.5874e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.51181e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "058", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6990.34,"maximum": 26880.9,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 15934, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 15175.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 15630.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15175.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 15175.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 15782.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 22269.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22844.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 15175.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 15934, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 15175.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 23521.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 20161.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 21170.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15175.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6990.34, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 15175.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 20043.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 18210.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 15175.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 19727.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 15175.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 22269.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 26880.9, "methodology": "case rate" }]}]} , { "description": "OTHER DISORDERS OF NERVOUS SYSTEM ", "code_information": [ { "code": "0581", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6429.46,"maximum": 6.28596e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.98663e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.98663e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6429.46, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.28596e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.98663e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.28596e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.98663e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.98663e+007, "methodology": "case rate" }]}]} , { "description": "OTHER DISORDERS OF NERVOUS SYSTEM ", "code_information": [ { "code": "0582", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7976.39,"maximum": 8.42183e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.02079e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.02079e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.02079e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.42183e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.02079e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.42183e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7976.39, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.02079e+007, "methodology": "case rate" }]}]} , { "description": "OTHER DISORDERS OF NERVOUS SYSTEM ", "code_information": [ { "code": "0583", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10978.9,"maximum": 1.08285e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10978.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.03129e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.03129e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.08285e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.03129e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.03129e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.08285e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.03129e+008, "methodology": "case rate" }]}]} , { "description": "OTHER DISORDERS OF NERVOUS SYSTEM ", "code_information": [ { "code": "0584", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 25335,"maximum": 1.55177e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.47788e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.47788e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.47788e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.55177e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.47788e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.47788e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.55177e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 25335, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "059", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6353.94,"maximum": 18469.3,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6353.94, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10531, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11057.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 14077, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10531, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10531, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10531, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 14077, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 12744.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 15696, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 10846.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 13771.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 18469.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10531, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10531, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14545.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 10952.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 16323, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10531, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 13690.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 12637.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10531, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10531, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11057.5, "methodology": "case rate" }]}]} , { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE ", "code_information": [ { "code": "0591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4.95914e+007,"maximum": 5.20709e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.95914e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.20709e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.95914e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.95914e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.95914e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.20709e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.95914e+007, "methodology": "case rate" }]}]} , { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE ", "code_information": [ { "code": "0592", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7.27499e+007,"maximum": 7.63874e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.27499e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.27499e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.63874e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.27499e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.27499e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.27499e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.63874e+007, "methodology": "case rate" }]}]} , { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE ", "code_information": [ { "code": "0593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.11526e+008,"maximum": 1.17102e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.17102e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.11526e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.11526e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.17102e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.11526e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.11526e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.11526e+008, "methodology": "case rate" }]}]} , { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE ", "code_information": [ { "code": "0594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.50765e+008,"maximum": 1.58303e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.50765e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.50765e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.58303e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.50765e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.50765e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.50765e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.58303e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "060", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6077.84,"maximum": 13960.9,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8041.78, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9650.14, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8041.78, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8041.78, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8041.78, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8443.87, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8041.78, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8041.78, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10994.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8443.87, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6077.84, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10409.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8283.03, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 10769.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8041.78, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 10769.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8363.45, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8041.78, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 12464.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 13960.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11864.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10454.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8041.78, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 9749.55, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "061", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11639.4,"maximum": 43603.2,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 25628.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 24408, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 25384.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 24408, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 35770.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 32384, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 25628.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 32512.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 24408, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 43603.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 25140.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 31730.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 35770.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 24408, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 11639.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 24408, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 34339.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 24408, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 29289.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 24408, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 24408, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 24408, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 37832.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 37055.8, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "062", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11651.8,"maximum": 29118,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 16902.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 17231, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 16410.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 16410.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 25436.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 24554, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 16410.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 29118, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 16410.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 11651.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 16410.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 16410.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 24554, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 17231, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 16410.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 16410.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 22229.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 17066.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 22932.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 16410.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 19692.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 21711.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 24745.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21333.6, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "063", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13104.4,"maximum": 23130.2,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 13759.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 20636.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13104.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 13368.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13104.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 13628.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13104.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13104.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 17246.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13104.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13104.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 18216.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 19657, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 23130.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 20636.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 13497.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 17035.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 15725.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 13759.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 18683.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13104.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13104.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 20311.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13104.4, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "064", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8522.55,"maximum": 31160.7,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 17538.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 27184.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 22799.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 17538.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 17538.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 17538.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 17538.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 21392.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 23234.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 18415.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 23629.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 17538.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8522.55, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 18415.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 17538.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 18239.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 23629.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 17538.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 31160.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 17538.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 26481.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 21045.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 18064.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 24540.8, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "065", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6816.19,"maximum": 15812.1,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11790.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9335.85, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9063.93, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9063.93, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9063.93, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 13235.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 14049.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9063.93, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6816.19, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9063.93, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13437.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9063.93, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 9517.13, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9426.49, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 12452.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9063.93, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9063.93, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 11982.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11783.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9063.93, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 15812.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 13235.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10876.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9517.13, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "066", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6238.89,"maximum": 10695.4,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9455.14, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6550.83, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8559.97, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6550.83, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6238.89, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9670.28, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6238.89, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 8423.25, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7149.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6238.89, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 7975, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9455.14, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6426.06, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6238.89, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9089.44, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8110.56, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6488.45, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6238.89, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 10695.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6238.89, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6238.89, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7486.67, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6238.89, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6238.89, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "067", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8333.76,"maximum": 22042.7,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 17359.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 12504, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 12504, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 12504, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 22042.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 12504, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 12504, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 12504, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 12504, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 13129.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 18732.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 13129.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 12504, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 19066.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 16255.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8333.76, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 13004.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 12504, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 15004.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 12879.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 19066.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 16436, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 19381.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 17261, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "068", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7815.04,"maximum": 13550.2,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10103.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9378.05, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7815.04, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11588, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 13550.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7815.04, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 12113.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11515.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8127.64, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10490.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10671.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7815.04, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7815.04, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8049.49, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7815.04, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7815.04, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8205.79, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8205.79, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7815.04, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7815.04, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11588, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7815.04, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8369.12, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10159.5, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "069", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7194.03,"maximum": 12425.4,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7194.03, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9352.24, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9935.31, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7409.85, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7194.03, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7758.78, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11150.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7553.73, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8632.84, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7194.03, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7553.73, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9264.92, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10559.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7194.03, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7194.03, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9935.31, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7481.79, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7194.03, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 12425.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7194.03, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9785.67, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7194.03, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7194.03, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8994.69, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "070", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7289.62,"maximum": 27839.3,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15704.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 16489.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 20851.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 15704.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 18877.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 18845.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 15704.4, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 20415.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 27839.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 15704.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 15704.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 16332.6, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 15704.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 21925, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 24341.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 16489.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 15704.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 23659, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 20758.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 20851.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 15704.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7289.62, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15704.4, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 16175.5, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "071", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6114.68,"maximum": 16518.4,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 12316.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 12668.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 14038.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 14653.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9832.05, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9453.89, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9737.51, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9453.89, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9453.89, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 16518.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9453.89, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9453.89, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 9926.58, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9453.89, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 13009.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9453.89, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9453.89, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9453.89, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11344.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 11469.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6114.68, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9926.58, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 12290.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 12668.7, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "072", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6527.76,"maximum": 12181.1,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7412.13, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7341.54, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7059.17, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9643.73, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7059.17, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 12181.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7059.17, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10941.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7059.17, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8471, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7059.17, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9643.73, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7059.17, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7059.17, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7270.95, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10352, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9082.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9593.32, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7059.17, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9176.92, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7059.17, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7412.13, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6527.76, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8730.72, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7673.26,"maximum": 23537.7,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 17328.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 13729.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 13995.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 18537.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 17550.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13329.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13329.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 23537.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7673.26, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13329.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 13995.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13329.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13329.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13329.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 20660.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 16246.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 20003.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 17945.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 17945.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13329.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 15995.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13329.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 13862.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13329.4, "methodology": "case rate" }]}]} , { "description": "ORBIT AND EYE PROCEDURES ", "code_information": [ { "code": "0731", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8589.16,"maximum": 7.46216e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8589.16, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.10682e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.10682e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.46216e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.10682e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.10682e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.10682e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.46216e+007, "methodology": "case rate" }]}]} , { "description": "ORBIT AND EYE PROCEDURES ", "code_information": [ { "code": "0732", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10152.7,"maximum": 9.41895e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.41895e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.97043e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.97043e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.97043e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10152.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.41895e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.97043e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.97043e+007, "methodology": "case rate" }]}]} , { "description": "ORBIT AND EYE PROCEDURES ", "code_information": [ { "code": "0733", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16968.4,"maximum": 1.46086e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.46086e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.39129e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.46086e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.39129e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.39129e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16968.4, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.39129e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.39129e+008, "methodology": "case rate" }]}]} , { "description": "ORBIT AND EYE PROCEDURES ", "code_information": [ { "code": "0734", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 36691.4,"maximum": 2.62876e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.50358e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.50358e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.62876e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.50358e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 36691.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.50358e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.62876e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.50358e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7109.63,"maximum": 15964.6,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9148.12, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9148.12, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7109.63, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9148.12, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9422.56, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9148.12, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9148.12, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 9605.53, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11903.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 12573, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 12521.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9148.12, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9514.04, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10977.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9605.53, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13567.4, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11892.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9148.12, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 12521.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 11335.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 15964.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9148.12, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9148.12, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 14179.6, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "075", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6572.7,"maximum": 29773,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 16772.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 25302.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 22200.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 16772.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 18820.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 17038.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 16772.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 17275.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 23447.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 17443, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 16772.1, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 16772.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 16772.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 16772.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21803.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 17610.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 16772.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 16772.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 18820.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 25996.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 29773, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6572.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 20126.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 17610.7, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "076", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5647.36,"maximum": 14351.3,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10701, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8505.12, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8670.27, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8257.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12196.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8257.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14351.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8670.27, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8587.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 12799, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8257.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8257.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8257.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9908.88, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10734.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 10671.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 5647.36, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8257.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 9660.81, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11302.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8257.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 10671.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8257.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8257.4, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "077", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7419.65,"maximum": 23505.1,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13311.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 13843.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7419.65, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 18511.5, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 13710.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 17526.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 19694, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 15973.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 19694, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13311.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 17829.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 13977, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13311.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13311.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13311.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 23505.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 19975.6, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 17304.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 13977, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13311.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 20632.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13311.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13311.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13311.4, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "078", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6895.71,"maximum": 15819.9,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9521.63, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9068.22, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9068.22, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9068.22, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9068.22, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10881.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 12459.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 12473.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6895.71, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 11293, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9068.22, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13444.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9068.22, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 9521.63, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9068.22, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 14055.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11788.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9340.27, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 12473.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9068.22, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11796, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9430.95, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9068.22, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 15819.9, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "079", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6696.7,"maximum": 11524.6,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11524.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8036.04, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9076.28, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7136.44, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8593.28, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6696.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6696.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6964.57, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8705.71, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10379.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6696.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7031.53, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6696.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9699.57, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6696.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8781.26, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9699.57, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6897.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6696.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6696.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9794.12, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7031.53, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6696.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6696.7, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "080", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7778.44,"maximum": 34360.8,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 19305.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 29201.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 34360.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 19305.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 20270.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 29922.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 23748.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 27061, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 19305.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 19884.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 20270.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 19305.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 25096.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 19305.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 23748.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 21500.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 20077.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 23166.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 19305.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7778.44, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 19305.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 25620.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 19305.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 19305.1, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "081", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6471.86,"maximum": 14149.1,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14149.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8145.72, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8553.01, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 12625.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9774.86, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10589.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11040.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12024.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8471.55, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10550.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8145.72, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8145.72, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8145.72, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8145.72, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8553.01, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8145.72, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8145.72, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11040.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8390.09, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6471.86, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 9995.55, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8145.72, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8145.72, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11143.2, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "082", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10012.6,"maximum": 35443.5,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 26428.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 24643.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 19902.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 27220.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 10012.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 19902.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 35443.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 20898.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 30121.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 30849.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 19902.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 19902.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 19902.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 20898.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 19902.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 19902.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 19902.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 19902.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 20699, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 27220.5, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 20500, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 27913.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 23883.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 25873.8, "methodology": "case rate" }]}]} , { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS ", "code_information": [ { "code": "0821", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5204.25,"maximum": 4.40404e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.19432e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.19432e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.19432e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.19432e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.40404e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5204.25, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.19432e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.40404e+007, "methodology": "case rate" }]}]} , { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS ", "code_information": [ { "code": "0822", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6513.19,"maximum": 5.41051e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.15287e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6513.19, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.41051e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.15287e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.15287e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.41051e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.15287e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.15287e+007, "methodology": "case rate" }]}]} , { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS ", "code_information": [ { "code": "0823", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9369.71,"maximum": 8.22528e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.22528e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.8336e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.8336e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.22528e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.8336e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9369.71, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.8336e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.8336e+007, "methodology": "case rate" }]}]} , { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS ", "code_information": [ { "code": "0824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16916.2,"maximum": 1.64986e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.5713e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.5713e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.5713e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.64986e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.5713e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.64986e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16916.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.5713e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "083", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7945.39,"maximum": 21101.5,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 14942.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11984.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 16505.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 11984.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 12343.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 11984.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 11984.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 11984.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 18575.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 16505.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7945.39, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 12463.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 12583.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 17933, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 12583.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 15734.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 16618.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 21101.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 11984.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11984.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 11984.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 11984.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 14381.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 15579.6, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "084", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8233.34,"maximum": 14307.8,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8233.34, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8645.01, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9880.01, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11893.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8233.34, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11893.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14307.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10767.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8233.34, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8487.66, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8233.34, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 12761.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8233.34, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10668.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8233.34, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8480.34, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12159.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8645.01, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10703.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8233.34, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8233.34, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8233.34, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8562.67, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11268.2, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "085", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9874.93,"maximum": 35357.9,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 19855.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 19855.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 24883.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 23826.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 19855.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 9874.93, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 27846.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 19855.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 30776.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 26364.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 19855.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 27486, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 25812.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 20848.4, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 20451.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 19855.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 19855.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 27486, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 20649.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 35357.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 19855.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 19855.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 30048.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 20848.4, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "086", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8716.06,"maximum": 20490.1,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 17413.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 16137.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 12229.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 13976.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 11646.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 15278.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 11646.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 11646.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 15861.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11646.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 20490.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 15861.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 11646.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 12229.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 11646.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 15140.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 11646.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8716.06, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11646.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11996.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 14359.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 12112.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 18052.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 11646.8, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "087", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7945.6,"maximum": 13786.6,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10329.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8483.22, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7945.6, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7945.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7945.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8263.42, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10279.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7945.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9534.72, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7945.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 13786.6, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8342.88, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 10925.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 9891.08, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7945.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10857.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7945.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8342.88, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7945.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8183.97, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 12315.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11716.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7945.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 10925.5, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8515.52,"maximum": 23861.3,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 18795.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 13913.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 23861.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 17560.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13508.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 14183.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 17792.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 16209.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13508.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 17016.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 18792.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13508.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14048.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13508.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13508.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13508.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8515.52, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13508.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13508.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 20937.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13508.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 18795.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 20278.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14183.5, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9083.77,"maximum": 17889,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 17889, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 12387, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10210.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14088.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 10619, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 13682.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10210.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 13338.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 12252.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 15826.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10210.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10210.6, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10210.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10210.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10210.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 10721.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10210.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 9083.77, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 13273.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10210.6, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 10721.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 13682.4, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 10516.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 15202.8, "methodology": "case rate" }]}]} , { "description": "MAJOR CRANIAL/FACIAL BONE PROCEDURES ", "code_information": [ { "code": "0891", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16914.7,"maximum": 1.24952e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.19002e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16914.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.19002e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.24952e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.19002e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.24952e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.19002e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.19002e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR CRANIAL/FACIAL BONE PROCEDURES ", "code_information": [ { "code": "0892", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21997.5,"maximum": 1.60069e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 21997.5, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.52447e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.52447e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.60069e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.60069e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.52447e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.52447e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.52447e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR CRANIAL/FACIAL BONE PROCEDURES ", "code_information": [ { "code": "0893", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 36764.7,"maximum": 2.89064e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.89064e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.75299e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.75299e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.75299e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 36764.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.75299e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.75299e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.89064e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR CRANIAL/FACIAL BONE PROCEDURES ", "code_information": [ { "code": "0894", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 65617.6,"maximum": 3.84408e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.66103e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.66103e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.66103e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 65617.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.84408e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.66103e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.84408e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.66103e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8363.04,"maximum": 14542.7,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 10281.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10035.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11453.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8363.04, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 12962.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12359, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8613.93, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8363.04, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8363.04, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8781.19, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8363.04, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8363.04, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10872, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8893.14, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8363.04, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8781.19, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 9308.09, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8363.04, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10843.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8697.56, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8363.04, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14542.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8363.04, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 10281.5, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "091", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7812.67,"maximum": 27834.6,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 15701.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 15701.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 20412.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 20754.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 15701.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 20438.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 20438.4, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 16486.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15701.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 24337.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 16172.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 23655, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7812.67, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 18503.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 27834.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 15701.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 15701.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 15701.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 18842.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 15701.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 16486.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 16329.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15701.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 21921.3, "methodology": "case rate" }]}]} , { "description": "OTHER MAJOR HEAD & NECK PROCEDURES ", "code_information": [ { "code": "0911", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14330,"maximum": 1.10263e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.10263e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 14330, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.05013e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.05013e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.05013e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.10263e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.05013e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.05013e+008, "methodology": "case rate" }]}]} , { "description": "OTHER MAJOR HEAD & NECK PROCEDURES ", "code_information": [ { "code": "0912", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21712.7,"maximum": 1.70271e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.70271e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 21712.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.70271e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.62163e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.62163e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.62163e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.62163e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.62163e+008, "methodology": "case rate" }]}]} , { "description": "OTHER MAJOR HEAD & NECK PROCEDURES ", "code_information": [ { "code": "0913", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 37236.5,"maximum": 2.93538e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.7956e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.7956e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.7956e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.7956e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.93538e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.93538e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 37236.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.7956e+008, "methodology": "case rate" }]}]} , { "description": "OTHER MAJOR HEAD & NECK PROCEDURES ", "code_information": [ { "code": "0914", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 58781.3,"maximum": 4.69331e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 58781.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.46982e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.69331e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.46982e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.46982e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.69331e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.46982e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.46982e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "092", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6667.98,"maximum": 15963,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9147.26, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9147.26, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9147.26, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9147.26, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9147.26, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11902.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9147.26, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 12571.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6667.98, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 15963, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 14178.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10976.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9147.26, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13566.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 9604.62, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9513.15, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 12141.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9147.26, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9604.62, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9421.68, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10991.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 12141.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9147.26, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11891.4, "methodology": "case rate" }]}]} , { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES ", "code_information": [ { "code": "0921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11834,"maximum": 1.02108e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.72455e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.72455e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.72455e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11834, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.72455e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.02108e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.02108e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.72455e+007, "methodology": "case rate" }]}]} , { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES ", "code_information": [ { "code": "0922", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16496.4,"maximum": 1.34105e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16496.4, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.27719e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.27719e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.27719e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.34105e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.27719e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.27719e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.34105e+008, "methodology": "case rate" }]}]} , { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES ", "code_information": [ { "code": "0923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 26062.7,"maximum": 2.08203e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.98288e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.98288e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.98288e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.08203e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 26062.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.08203e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.98288e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.98288e+008, "methodology": "case rate" }]}]} , { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES ", "code_information": [ { "code": "0924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 51793.1,"maximum": 3.98092e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.98092e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 51793.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.98092e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.79135e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.79135e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.79135e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.79135e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.79135e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "093", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6985.31,"maximum": 12047.3,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10238.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7264.72, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6985.31, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7082.78, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10827.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7334.58, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8683.54, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6985.31, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9591.62, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6985.31, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8983.04, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6985.31, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6985.31, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 12047.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6985.31, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7334.58, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9591.62, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8382.37, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6985.31, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7194.87, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9487.95, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6985.31, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6985.31, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9080.9, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8579.93,"maximum": 56358.3,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 44385.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 56358.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 37740.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 42023.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 31450.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 47895.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 31450.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 32708.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 31450.5, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 32394, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 33023, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 31450.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 31450.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 40885.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 41709.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8579.93, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 31450.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 48748.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 46071.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 33023, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 46071.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 31450.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 31450.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 31450.5, "methodology": "case rate" }]}]} , { "description": "Other Therapeutic Services", "code_information": [ { "code": "0940", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 278.06,"minimum": 12.3,"maximum": 5264,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 27.81, "standard_charge_percentage": 10.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 152.93, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 83.42, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 152.93, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 222.45, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 152.93, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 222.45, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8427.91,"maximum": 37091,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 27656.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 37091, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 20812.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 21853.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 20812.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 20812.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 29978.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 20812.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 20812.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 20812.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 27140.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 21645, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 24975, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 20812.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 21853.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 20812.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 29978.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 21436.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8427.91, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 20812.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 29211.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 27056.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 32259.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 31521.5, "methodology": "case rate" }]}]} , { "description": "CLEFT LIP & PALATE REPAIR ", "code_information": [ { "code": "0951", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7958.78,"maximum": 6.22418e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.92779e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.92779e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.92779e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.92779e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.22418e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7958.78, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.92779e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.22418e+007, "methodology": "case rate" }]}]} , { "description": "CLEFT LIP & PALATE REPAIR ", "code_information": [ { "code": "0952", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9242.86,"maximum": 7.01414e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.68013e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.68013e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.68013e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.01414e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9242.86, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.68013e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.01414e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.68013e+007, "methodology": "case rate" }]}]} , { "description": "CLEFT LIP & PALATE REPAIR ", "code_information": [ { "code": "0953", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14166.2,"maximum": 1.1747e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.1747e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.1747e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.11876e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.11876e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 14166.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.11876e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.11876e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.11876e+008, "methodology": "case rate" }]}]} , { "description": "CLEFT LIP & PALATE REPAIR ", "code_information": [ { "code": "0954", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 29236.3,"maximum": 2.19347e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.08902e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 29236.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.08902e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.08902e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.08902e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.08902e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.19347e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.19347e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9872.24,"maximum": 33909.6,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 19056, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 20008.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 26629.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 29536.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 19056, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 22867.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 24108.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 19056, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 19056, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 25284.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 19056, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 9872.24, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 19627.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 28817.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 19056, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 19056, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 19056, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 26705.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 33909.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 26629.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 24772.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 19056, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 19818.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 20008.8, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "097", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8309.64,"maximum": 56579.3,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 32519.6, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 41044.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 31572.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 48083.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 31572.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 44346.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 31572.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 31572.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 37886.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 48937.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 32835.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 44346.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 31572.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 33151.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 31572.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8309.64, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 33151.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 40148.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 31572.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 56579.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 31572.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 42188, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 31572.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 44559.3, "methodology": "case rate" }]}]} , { "description": "TONSIL & ADENOID PROCEDURES ", "code_information": [ { "code": "0971", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4815,"maximum": 4.49014e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.49014e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.49014e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4815, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.27633e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.27633e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.27633e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.27633e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.27633e+007, "methodology": "case rate" }]}]} , { "description": "TONSIL & ADENOID PROCEDURES ", "code_information": [ { "code": "0972", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7391.43,"maximum": 6.63851e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.32239e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7391.43, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.32239e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.32239e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.32239e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.63851e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.63851e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.32239e+007, "methodology": "case rate" }]}]} , { "description": "TONSIL & ADENOID PROCEDURES ", "code_information": [ { "code": "0973", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14363,"maximum": 1.08391e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.08391e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.0323e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.0323e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.0323e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.08391e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.0323e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.0323e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 14363, "methodology": "case rate" }]}]} , { "description": "TONSIL & ADENOID PROCEDURES ", "code_information": [ { "code": "0974", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 48524.8,"maximum": 1.92809e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.83628e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 48524.8, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.83628e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.92809e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.83628e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.83628e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.92809e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.83628e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "098", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6988.54,"maximum": 33517.6,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 29201.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 18839.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 19593.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 23397.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 18839.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 24992.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 19781.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 21182.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 19781.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 18839.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 28484.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 23397.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 19404.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 26396.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6988.54, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 18839.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 18839.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 24491.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 22607.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 18839.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 18839.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 18839.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 33517.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 18839.5, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES ", "code_information": [ { "code": "0981", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8440.21,"maximum": 6.59919e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.28494e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.28494e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.59919e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.28494e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8440.21, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.28494e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.28494e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.59919e+007, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES ", "code_information": [ { "code": "0982", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11127.8,"maximum": 9.26109e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11127.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.26109e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.82008e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.82008e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.82008e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.82008e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.26109e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.82008e+007, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES ", "code_information": [ { "code": "0983", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 17908.8,"maximum": 1.54959e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.4758e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.54959e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.4758e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.4758e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 17908.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.4758e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.4758e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.54959e+008, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES ", "code_information": [ { "code": "0984", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 37353.4,"maximum": 2.83742e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 37353.4, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.7023e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.7023e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.83742e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.7023e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.83742e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.7023e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.7023e+008, "methodology": "case rate" }]}]} , { "description": "UnGrouped", "code_information": [ { "code": "099", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7350.82,"maximum": 20538.3,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 11673.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 11673.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 11673.4, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 12023.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 11673.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 16231, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 12257.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 11673.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 11673.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 12140.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 15175.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 20538.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11673.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 15314.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 16231, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 18093.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 14694.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11673.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 14008.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 17454.4, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 12257.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 11673.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7350.82, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 16175.1, "methodology": "case rate" }]}]} , { "description": "SEIZURES WITH MCC", "code_information": [ { "code": "100", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8490.82,"maximum": 30841.8,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 22997, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 24289.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 18230.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 17362.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 22924.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 17362.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 17362.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 18230.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 22924.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8490.82, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 17883, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 20754.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 17362.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 17362.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 22570.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 17362.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 18056.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 20834.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 26911.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 26210.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 17362.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 17362.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 30841.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 17362.2, "methodology": "case rate" }]}]} , { "description": "Fna bx w/us gdn 1st les", "code_information": [ { "code": "10005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 903,"minimum": 18.16,"maximum": 2896.7,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 869.01, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1593.18, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2896.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "FNA BX W/US GDN EA ADDL", "code_information": [ { "code": "10006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500,"minimum": 18.16,"maximum": 500,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 40.71, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 44.78, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 40.71, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 275, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 40.71, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 500, "methodology": "case rate" }]}]} , { "description": "Fna bx w/fluor gdn 1st les", "code_information": [ { "code": "10007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 903,"minimum": 18.16,"maximum": 2896.7,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2896.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 869.01, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1593.18, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "FNA BX W/FLUOR GDN EA ADDL", "code_information": [ { "code": "10008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500,"minimum": 18.16,"maximum": 500,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 50.01, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 55.01, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 275, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 50.01, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 50.01, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 500, "methodology": "case rate" }]}]} , { "description": "Fna bx w/ct gdn 1st les", "code_information": [ { "code": "10009", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 903,"minimum": 18.16,"maximum": 2896.7,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2896.7, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 869.01, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1593.18, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" }]}]} , { "description": "Fna bx w/ct gdn ea addl", "code_information": [ { "code": "10010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500,"minimum": 18.16,"maximum": 500,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 275, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 67.99, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 67.99, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 74.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 67.99, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" }]}]} , { "description": "FNA BX W/MR GDN 1ST LES", "code_information": [ { "code": "10011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 903,"minimum": 18.16,"maximum": 2896.7,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 134.24, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1593.18, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 134.24, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 869.01, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 147.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 134.24, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2896.7, "methodology": "case rate" }]}]} , { "description": "Fna bx w/mr gdn ea addl", "code_information": [ { "code": "10012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500,"minimum": 18.16,"maximum": 500,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 131.31, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 131.31, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 144.44, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 275, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 131.31, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" }]}]} , { "description": "FNA W/O IMAGE", "code_information": [ { "code": "10021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189, "discounted_cash": 511,"minimum": 18.16,"maximum": 189,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 189, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 189, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 103.95, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 56.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 189, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 151.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 151.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 189, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 189, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 189, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 189, "methodology": "fee schedule" }]}]} , { "description": "Img gid flu coll drg sft tis", "code_information": [ { "code": "10030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 504, "discounted_cash": 903,"minimum": 18.16,"maximum": 504,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 504, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 504, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 504, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 277.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 504, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 403.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 504, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 151.2, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 504, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 137.81, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 125.28, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 125.28, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 403.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 125.28, "methodology": "fee schedule" }]}]} , { "description": "Acne surgery", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 765.6, "discounted_cash": 256,"minimum": 18.16,"maximum": 765.6,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 229.68, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 765.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 765.6, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 765.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 612.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 22, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 421.08, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 612.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" }]}]} , { "description": "I&d abscess simple/single", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 891.44, "discounted_cash": 256,"minimum": 18.16,"maximum": 891.44,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 619, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 713.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 891.44, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 490.29, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 713.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 619, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 680.9, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 619, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 891.44, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 891.44, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 267.43, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" }]}]} , { "description": "I&D ABSCESS COMP/MULTIPLE", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1200.71, "discounted_cash": 511,"minimum": 18.16,"maximum": 1200.71,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 600, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 600, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 660.39, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1200.71, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 600, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1200.71, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 660, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.57, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.21, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 960.57, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1200.71, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" }]}]} , { "description": "I&d pilonidal cyst simple", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 891.44, "discounted_cash": 903,"minimum": 18.16,"maximum": 891.44,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 490.29, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 891.44, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 891.44, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 713.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 891.44, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 713.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 891.44, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 267.43, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 891.44, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 891.44, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 891.44, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 891.44, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 891.44, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" }]}]} , { "description": "I&D PILONIDAL CYST COMP", "code_information": [ { "code": "10081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1363.4, "discounted_cash": 903,"minimum": 18.16,"maximum": 1363.4,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 568, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1363.4, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1363.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1363.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 749.87, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1363.4, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1090.72, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 409.02, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1363.4, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 568, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1363.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 568, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 624.8, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1090.72, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" }]}]} , { "description": "SEIZURES WITHOUT MCC", "code_information": [ { "code": "101", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6743.22,"maximum": 14150.7,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11144.4, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8390.97, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8472.43, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8146.57, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8553.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9775.88, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14150.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 12627.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8146.57, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8146.57, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11223.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8146.57, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8146.57, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10160.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10551.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8146.57, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8146.57, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10590.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6743.22, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8146.57, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8146.57, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8553.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12025.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11223.2, "methodology": "case rate" }]}]} , { "description": "Inc&rmvl fb subq tiss smpl", "code_information": [ { "code": "10120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1597.55, "discounted_cash": 511,"minimum": 18.16,"maximum": 5594.4,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 777, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 479.26, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 854.7, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 777, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 777, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1278.04, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1278.04, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 878.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 777, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 777, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1597.55, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 854.7, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3846.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1597.55, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 777, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2097.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" }]}]} , { "description": "INC&RMVL FB SUBQ TISS COMP", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3946.25, "discounted_cash": 2080,"minimum": 18.16,"maximum": 3800.79,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1183.88, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2170.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 3157, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 720, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3157, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 792, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 720, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "I&d hmtma seroma/fluid collj", "code_information": [ { "code": "10140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5155.81, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4124.65,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4124.65, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4124.65, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2835.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1546.74, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 619, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 680.9, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 619, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 619, "methodology": "fee schedule" }]}]} , { "description": "Pnxr aspir absc hmtma bulla", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 891.44, "discounted_cash": 511,"minimum": 18.16,"maximum": 891.44,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 713.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 267.43, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 713.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 891.44, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 891.44, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 891.44, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 891.44, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 490.29, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" }]}]} , { "description": "I&D COMPLEX PO WOUND INFCTJ", "code_information": [ { "code": "10180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5040, "discounted_cash": 3647,"minimum": 18.16,"maximum": 5040,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1512, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4032, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5040, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5040, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4032, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5040, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2772, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" }]}]} , { "description": "HEADACHES WITH MCC", "code_information": [ { "code": "102", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7454.42,"maximum": 18771.1,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10697.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 16581.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10697.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 13794.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10697.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 18771.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 12488.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 13906.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10697.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 12837.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 15952.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10697.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11125.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10697.6, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11232.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 13794.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7454.42, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10697.6, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10697.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14783.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 13996.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10697.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11018.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11232.5, "methodology": "case rate" }]}]} , { "description": "HEADACHES WITHOUT MCC", "code_information": [ { "code": "103", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7039.33,"maximum": 13105.2,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 10132.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7947.86, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7569.39, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7796.47, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7947.86, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7569.39, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11732.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9083.27, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7039.33, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 13105.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7872.17, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9771.84, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 9173.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7569.39, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7569.39, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9840.21, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7569.39, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7569.39, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 10132.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10321.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7569.39, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7569.39, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7569.39, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11137.4, "methodology": "case rate" }]}]} , { "description": "Dbrdmt ecz/infected skin<10%", "code_information": [ { "code": "11000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5040, "discounted_cash": 806,"minimum": 18.16,"maximum": 4032,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4032, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1512, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4032, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 666.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2772, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "DBRDMT ECZ/INFCT SKN EA ADDL", "code_information": [ { "code": "11001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.32,"minimum": 14.81,"maximum": 215.32,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 215.32, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 14.81, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 215.32, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 215.32, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 14.81, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 64.6, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 118.43, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 172.26, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 215.32, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 16.29, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 14.81, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 215.32, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 172.26, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Dbrdmt skin xtrnl gent&per", "code_information": [ { "code": "11004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2520.8,"minimum": 18.16,"maximum": 2520.8,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1386.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 756.24, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2520.8, "methodology": "case rate" }]}]} , { "description": "DBRDMT SKIN ABDOMINAL WALL", "code_information": [ { "code": "11005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3251,"minimum": 18.16,"maximum": 3251,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2600.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3251, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1788.05, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2600.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 975.3, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Dbrdmt skin xtrnl gent per", "code_information": [ { "code": "11006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2520.8,"minimum": 18.16,"maximum": 2520.8,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1386.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1386.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2520.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 756.24, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1386.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "RMV PRSTC MTRL/MESH ABD WALL", "code_information": [ { "code": "11008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4036.75,"minimum": 18.16,"maximum": 4036.75,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3229.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1211.03, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2220.21, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 3229.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4036.75, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" }]}]} , { "description": "EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES ", "code_information": [ { "code": "1101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6610.12,"maximum": 6.10438e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.81369e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.10438e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.81369e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.10438e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.81369e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.81369e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6610.12, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.81369e+007, "methodology": "case rate" }]}]} , { "description": "Debride skin at fx site", "code_information": [ { "code": "11010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5517, "discounted_cash": 903,"minimum": 18.16,"maximum": 4413.6,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1655.1, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4413.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3034.35, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4413.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" }]}]} , { "description": "EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES ", "code_information": [ { "code": "1102", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8486.91,"maximum": 7.03161e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.69677e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.03161e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.69677e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.03161e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8486.91, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.69677e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.69677e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.69677e+007, "methodology": "case rate" }]}]} , { "description": "EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES ", "code_information": [ { "code": "1103", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13722.5,"maximum": 1.02407e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.75307e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.75307e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 13722.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.02407e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.75307e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.02407e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.75307e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.75307e+007, "methodology": "case rate" }]}]} , { "description": "EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES ", "code_information": [ { "code": "1104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 25108.8,"maximum": 1.7681e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.7681e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.7681e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.68391e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.68391e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.68391e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.68391e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 25108.8, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.68391e+008, "methodology": "case rate" }]}]} , { "description": "Dbrdmt subq tis 1st 20sqcm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2299, "discounted_cash": 511,"minimum": 18.16,"maximum": 5474.4,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 666.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1839.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1264.45, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2299, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 689.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2299, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2052.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1839.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 666.6, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3763.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" }]}]} , { "description": "DBRDMT MUSC&/FSCA 1ST 20/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8493, "discounted_cash": 806,"minimum": 18.16,"maximum": 6794.4,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1839.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6794.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 689.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2299, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 666.6, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1839.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2299, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6794.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1264.45, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2547.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4671.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 666.6, "methodology": "fee schedule" }]}]} , { "description": "Dbrdmt bone 1st 20 sq cm/<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843, "discounted_cash": 2080,"minimum": 18.16,"maximum": 5474.4,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2299, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 689.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1839.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 2299, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2299, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 666.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2299, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2052.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1839.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 666.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2299, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2299, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3763.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1264.45, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 606, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2299, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" }]}]} , { "description": "DBRDMT SUBQ TISS EACH ADDL", "code_information": [ { "code": "11045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2299,"minimum": 18.16,"maximum": 2299,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 689.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2299, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1839.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1264.45, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1839.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2299, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "Dbrdmt musc&/fsca ea addl", "code_information": [ { "code": "11046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2299,"minimum": 18.16,"maximum": 2299,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1839.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1839.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2299, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2299, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1264.45, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 689.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "DBRDMT BONE EACH ADDL", "code_information": [ { "code": "11047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2674.98,"minimum": 18.16,"maximum": 2674.98,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2674.98, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2139.98, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1471.24, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2139.98, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 802.49, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Paring/cutg b9 hyprker les 1", "code_information": [ { "code": "11055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 735, "discounted_cash": 256,"minimum": 18.16,"maximum": 735,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 588, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 404.25, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 588, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 735, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 735, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 735, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 735, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 735, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 735, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 220.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 735, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" }]}]} , { "description": "PARNG/CUTG B9 HYPRKR LES 2-4", "code_information": [ { "code": "11056", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.38, "discounted_cash": 256,"minimum": 18.16,"maximum": 183.38,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 55.01, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 100.86, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 146.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 146.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 183.38, "methodology": "fee schedule" }]}]} , { "description": "Parng/cutg b9 hyprkr les >4", "code_information": [ { "code": "11057", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 623.45, "discounted_cash": 256,"minimum": 18.16,"maximum": 623.45,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 623.45, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 623.45, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 623.45, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 623.45, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 623.45, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 187.03, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 342.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 623.45, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 623.45, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 498.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 498.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "TANGNTL BX SKIN SINGLE LES", "code_information": [ { "code": "11102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.25, "discounted_cash": 256,"minimum": 18.16,"maximum": 882.25,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 264.68, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 882.25, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 882.25, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 882.25, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 485.24, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" }]}]} , { "description": "Tangntl bx skin ea sep/addl", "code_information": [ { "code": "11103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500,"minimum": 18.16,"maximum": 500,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 275, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 20.52, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 18.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 18.65, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 18.65, "methodology": "fee schedule" }]}]} , { "description": "PUNCH BX SKIN SINGLE LESION", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.25, "discounted_cash": 511,"minimum": 18.16,"maximum": 882.25,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 485.24, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 882.25, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 882.25, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 264.68, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 882.25, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 882.25, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" }]}]} , { "description": "Punch bx skin ea sep/addl", "code_information": [ { "code": "11105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500,"minimum": 18.16,"maximum": 500,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 22.05, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 22.05, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 22.05, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 275, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 24.26, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "INCAL BX SKN SINGLE LES", "code_information": [ { "code": "11106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1570.4, "discounted_cash": 806,"minimum": 18.16,"maximum": 1570.4,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 471.12, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 863.72, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1256.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1570.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1256.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1570.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" }]}]} , { "description": "Incal bx skn ea sep/addl", "code_information": [ { "code": "11107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1334.83,"minimum": 18.16,"maximum": 1334.83,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 400.45, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 26.29, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1067.86, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 26.29, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 28.92, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1067.86, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1334.83, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1334.83, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 26.29, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 734.16, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1334.83, "methodology": "case rate" }]}]} , { "description": "VERTIGO & OTHER LABYRINTH DISORDERS ", "code_information": [ { "code": "1111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5390.41,"maximum": 4.43337e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.22225e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5390.41, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.22225e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.22225e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.43337e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.22225e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.22225e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.43337e+007, "methodology": "case rate" }]}]} , { "description": "VERTIGO & OTHER LABYRINTH DISORDERS ", "code_information": [ { "code": "1112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5976.91,"maximum": 4.91757e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.6834e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.6834e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.6834e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.6834e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.6834e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.91757e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5976.91, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.91757e+007, "methodology": "case rate" }]}]} , { "description": "VERTIGO & OTHER LABYRINTH DISORDERS ", "code_information": [ { "code": "1113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7491.31,"maximum": 6.05072e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.76259e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.05072e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.76259e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.05072e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.76259e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.76259e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7491.31, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.76259e+007, "methodology": "case rate" }]}]} , { "description": "VERTIGO & OTHER LABYRINTH DISORDERS ", "code_information": [ { "code": "1114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15689.2,"maximum": 1.30624e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15689.2, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.24403e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.24403e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.24403e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.24403e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.24403e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.30624e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.30624e+008, "methodology": "case rate" }]}]} , { "description": "RMVL SKIN TAGS UP TO&INC 15", "code_information": [ { "code": "11200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1111.04, "discounted_cash": 256,"minimum": 18.16,"maximum": 1111.04,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 333.31, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1111.04, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 611.07, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1111.04, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1111.04, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 888.83, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 888.83, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" }]}]} , { "description": "ORBITAL PROCEDURES WITH CC/MCC", "code_information": [ { "code": "113", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9703.69,"maximum": 39006.1,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 26262, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 22963.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 22963.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 21869.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 28430.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 9703.69, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 29008.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 29008.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 30719.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 26243.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 33898.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 22744.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 21869.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 33149, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 21869.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 29084.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 21869.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 21869.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 22526, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 39006.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 21869.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 21869.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 21869.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 21869.9, "methodology": "case rate" }]}]} , { "description": "INFECTIONS OF UPPER RESPIRATORY TRACT ", "code_information": [ { "code": "1131", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3248.39,"maximum": 2.63381e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.63381e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.50839e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.50839e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.50839e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 3248.39, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.50839e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.50839e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.63381e+007, "methodology": "case rate" }]}]} , { "description": "INFECTIONS OF UPPER RESPIRATORY TRACT ", "code_information": [ { "code": "1132", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4732.87,"maximum": 3.664e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4732.87, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.48952e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.48952e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.48952e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.48952e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.48952e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.664e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.664e+007, "methodology": "case rate" }]}]} , { "description": "INFECTIONS OF UPPER RESPIRATORY TRACT ", "code_information": [ { "code": "1133", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7364.33,"maximum": 5.39242e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.13564e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.13564e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7364.33, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.39242e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.39242e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.13564e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.13564e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.13564e+007, "methodology": "case rate" }]}]} , { "description": "INFECTIONS OF UPPER RESPIRATORY TRACT ", "code_information": [ { "code": "1134", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15526,"maximum": 1.14793e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.09327e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.09327e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15526, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.09327e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.14793e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.09327e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.14793e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.09327e+008, "methodology": "case rate" }]}]} , { "description": "ORBITAL PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "114", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10914.1,"maximum": 19163.1,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10914.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 14188.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11459.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10914.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10914.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10914.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 13096.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 16916.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 16010.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 19163.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11350.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10914.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16285.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10914.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 11016, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10914.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 16010.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10914.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11241.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 15092, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 14288.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11459.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10914.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 14494.4, "methodology": "case rate" }]}]} , { "description": "EXC TR-EXT B9+MARG 1.1-2 CM", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 592, "discounted_cash": 903,"minimum": 18.16,"maximum": 592,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 325.6, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 592, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 473.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 592, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 592, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 177.6, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 473.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 592, "methodology": "fee schedule" }]}]} , { "description": "Exc tr-ext b9+marg >4.0 cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843, "discounted_cash": 2080,"minimum": 18.16,"maximum": 5474.4,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 837, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 920.7, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3763.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 837, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2052.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 837, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "DENTAL DISEASES AND DISORDERS ", "code_information": [ { "code": "1141", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4693.15,"maximum": 3.08619e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.93923e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.93923e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4693.15, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.93923e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.08619e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.93923e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.93923e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.08619e+007, "methodology": "case rate" }]}]} , { "description": "DENTAL DISEASES AND DISORDERS ", "code_information": [ { "code": "1142", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6577.31,"maximum": 4.3641e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.15629e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.15629e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6577.31, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.3641e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.3641e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.15629e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.15629e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.15629e+007, "methodology": "case rate" }]}]} , { "description": "Exc h-f-nk-sp b9+marg 0.5/<", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1145, "discounted_cash": 2080,"minimum": 18.16,"maximum": 1145,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1145, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 629.2, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1145, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 629.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1145, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 343.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 572, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1145, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 916, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 916, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 572, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 572, "methodology": "fee schedule" }]}]} , { "description": "EXC HFNKSP B9+MARG 0.61", "code_information": [ { "code": "11421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1301, "discounted_cash": 903,"minimum": 18.16,"maximum": 1301,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1301, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1301, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 715.55, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 678, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1040.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1301, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 678, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 745.8, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 678, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1040.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1301, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 390.3, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1301, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1301, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" }]}]} , { "description": "Exc h-f-nk-sp b9+marg 1.1-2", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1455, "discounted_cash": 2080,"minimum": 18.16,"maximum": 1455,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1455, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1164, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 741, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 741, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1455, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 815.1, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 800.25, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1455, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1164, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 436.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1455, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 741, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1455, "methodology": "fee schedule" }]}]} , { "description": "EXC HFNKSP B9+MARG 2.13", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1716, "discounted_cash": 2080,"minimum": 18.16,"maximum": 1716,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 760.1, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1372.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1372.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 691, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 943.8, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 691, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 691, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 514.8, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1716, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1716, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "Exc h-f-nk-sp b9+marg 3.1-4", "code_information": [ { "code": "11424", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5040, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4032,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2772, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1512, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4032, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4032, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" }]}]} , { "description": "EXC H-F-NK-SP B9+MARG >4 CM", "code_information": [ { "code": "11426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 846, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 846, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 846, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 930.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" }]}]} , { "description": "DENTAL DISEASES AND DISORDERS ", "code_information": [ { "code": "1143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11041.3,"maximum": 6.53555e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.22433e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11041.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.53555e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.22433e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.22433e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.53555e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.22433e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.22433e+007, "methodology": "case rate" }]}]} , { "description": "DENTAL DISEASES AND DISORDERS ", "code_information": [ { "code": "1144", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23026,"maximum": 1.34186e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.27797e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.34186e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.27797e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.34186e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.27797e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.27797e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 23026, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.27797e+008, "methodology": "case rate" }]}]} , { "description": "Exc face-mm b9+marg 0.5 cm/<", "code_information": [ { "code": "11440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 992, "discounted_cash": 903,"minimum": 18.16,"maximum": 992,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 992, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 992, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 992, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 793.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 992, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 793.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 992, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 992, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 992, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 992, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 545.6, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 297.6, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "EXC FACE-MM B9+MARG 0.6-1 CM", "code_information": [ { "code": "11441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 903,"minimum": 18.16,"maximum": 2695.55,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2695.55, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 527, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1482.55, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 527, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 808.66, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 527, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 579.7, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" }]}]} , { "description": "Exc face-mm b9+marg 1.1-2 cm", "code_information": [ { "code": "11442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 592, "discounted_cash": 903,"minimum": 18.16,"maximum": 592,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 177.6, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 325.6, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 473.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 473.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 592, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 592, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 592, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 592, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 592, "methodology": "fee schedule" }]}]} , { "description": "EXC FACE-MM B9+MARG 2.1-3 CM", "code_information": [ { "code": "11443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 920, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 920, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1012, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 920, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "Exc face-mm b9+marg 3.1-4 cm", "code_information": [ { "code": "11444", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 5474.4,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2052.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3763.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "EXC FACE-MM B9+MARG >4 CM", "code_information": [ { "code": "11446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 580, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 580, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 580, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 638, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" }]}]} , { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7774.59,"maximum": 24337.4,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13770.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 14184.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 17337.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13770.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 17902.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13770.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13770.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13770.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 16525.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 19167, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 18147, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7774.59, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 14459.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13770.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 24337.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14321.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 20682.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13770.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 17337.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13770.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14459.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13770.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 21344.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 15696.3, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES ", "code_information": [ { "code": "1151", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4821.66,"maximum": 3.82811e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.82811e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.64582e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.64582e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.64582e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.64582e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4821.66, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.64582e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.82811e+007, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES ", "code_information": [ { "code": "1152", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6419.01,"maximum": 5.2333e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6419.01, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.9841e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.9841e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.2333e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.9841e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.9841e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.2333e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.9841e+007, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES ", "code_information": [ { "code": "1153", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9589.89,"maximum": 8.20094e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.81042e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.20094e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.81042e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.20094e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.81042e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.81042e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9589.89, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.81042e+007, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES ", "code_information": [ { "code": "1154", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 19681.3,"maximum": 1.45162e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.45162e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.3825e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.3825e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.3825e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.3825e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 19681.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.45162e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.3825e+008, "methodology": "case rate" }]}]} , { "description": "INTRAOCULAR PROCEDURES WITH CC/MCC", "code_information": [ { "code": "116", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8948.45,"maximum": 28481.8,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 16701.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 16862.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8948.45, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 16059.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 24891.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 19271, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 21237.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 21629.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 16059.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 28481.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 16059.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 16059.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 19581.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 24205, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 16059.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 20876.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 22431, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 16862.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 21629.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 16059.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 16059.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 16059.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 16540.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 16059.1, "methodology": "case rate" }]}]} , { "description": "EXC TR-EXT MAL+MARG 0.5 CM/<", "code_information": [ { "code": "11600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 903,"minimum": 18.16,"maximum": 2695.55,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1482.55, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 808.66, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2695.55, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc tr-ext mal+marg 0.6-1 cm", "code_information": [ { "code": "11601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 903,"minimum": 18.16,"maximum": 2695.55,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1482.55, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 808.66, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2695.55, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" }]}]} , { "description": "EXC TR-EXT MAL+MARG 1.1-2 CM", "code_information": [ { "code": "11602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1463.1, "discounted_cash": 511,"minimum": 18.16,"maximum": 1463.1,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 438.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1170.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 804.71, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1170.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" }]}]} , { "description": "Exc tr-ext mal+marg 2.1-3 cm", "code_information": [ { "code": "11603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 903,"minimum": 18.16,"maximum": 2695.55,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2695.55, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1482.55, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 808.66, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" }]}]} , { "description": "EXC TR-EXT MAL+MARG 3.1-4 CM", "code_information": [ { "code": "11604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 903,"minimum": 18.16,"maximum": 2695.55,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1482.55, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 808.66, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2695.55, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" }]}]} , { "description": "Exc tr-ext mal+marg >4 cm", "code_information": [ { "code": "11606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "Exc h-f-nk-sp mal+marg 0.5/<", "code_information": [ { "code": "11620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "EXC S/N/H/F/G MAL+MRG 0.6-1", "code_information": [ { "code": "11621", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 903,"minimum": 18.16,"maximum": 2695.55,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1482.55, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 808.66, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2695.55, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" }]}]} , { "description": "Exc s/n/h/f/g mal+mrg 1.1-2", "code_information": [ { "code": "11622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 903,"minimum": 18.16,"maximum": 2695.55,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2695.55, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1482.55, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 808.66, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" }]}]} , { "description": "EXC S/N/H/F/G MAL+MRG 2.1-3", "code_information": [ { "code": "11623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "Exc s/n/h/f/g mal+mrg 3.1-4", "code_information": [ { "code": "11624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" }]}]} , { "description": "EXC S/N/H/F/G MAL+MRG >4 CM", "code_information": [ { "code": "11626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "INTRAOCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "117", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9194.27,"maximum": 18643.5,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10627.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 10946, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10627.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 13815.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11052.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11158.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 15844, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10627.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10627.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 11656.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 12752.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10627.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10627.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10627.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 9194.27, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10627.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 12875.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11158.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 18643.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10627.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14682.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 12875.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 16472.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 13901.4, "methodology": "case rate" }]}]} , { "description": "Trim nail(s) any number", "code_information": [ { "code": "11719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152, "discounted_cash": 78,"minimum": 18.16,"maximum": 152,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 62.2, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 83.6, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 93.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 123.2, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 120.78, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 84.55, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 62.81, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 143.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 152, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 121.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 90.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 48.31, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 152, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 63.41, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 121.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 152, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 66.43, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 72.47, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 45.6, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" }]}]} , { "description": "Debride nail 1-5", "code_information": [ { "code": "11720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.38, "discounted_cash": 78,"minimum": 15.57,"maximum": 183.38,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 62.81, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 48.31, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 62.2, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 93.6, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 55.01, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 120.78, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 146.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 90.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 63.41, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 146.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 66.43, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 143.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 72.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 100.86, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 15.57, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 15.57, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 123.2, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 84.55, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 15.57, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 17.13, "methodology": "fee schedule" }]}]} , { "description": "DEBRIDE NAIL 6 OR MORE", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.38, "discounted_cash": 78,"minimum": 18.16,"maximum": 183.38,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 100.86, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 84.55, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 55.01, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 93.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 66.43, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 120.78, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 22, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 143.39, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 63.41, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 146.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 62.81, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 72.47, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 62.2, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 90.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 146.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 48.31, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 123.2, "methodology": "fee schedule" }]}]} , { "description": "REMOVAL OF NAIL PLATE", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7533, "discounted_cash": 256,"minimum": 18.16,"maximum": 6026.4,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 677.81, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 677.81, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 677.81, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 372.8, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 677.81, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 542.25, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 542.25, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 677.81, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 677.81, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2259.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 677.81, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4143.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 203.34, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" }]}]} , { "description": "Remove nail plate add-on", "code_information": [ { "code": "11732", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 772.5,"minimum": 18.16,"maximum": 772.5,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 772.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 618, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 772.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 424.88, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 231.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 618, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 772.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" }]}]} , { "description": "DRAIN BLOOD FROM UNDER NAIL", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.13, "discounted_cash": 163,"minimum": 18.16,"maximum": 319.13,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 129.9, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 255.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 189.18, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 100.9, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 319.13, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 319.13, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 252.24, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 319.13, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 176.57, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 299.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 319.13, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 151.34, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 138.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 175.52, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 131.16, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 95.74, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 319.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 257.28, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 319.13, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 195.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 319.13, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 319.13, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 255.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 132.43, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 319.13, "methodology": "fee schedule" }]}]} , { "description": "Removal of nail bed", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7743, "discounted_cash": 511,"minimum": 18.16,"maximum": 6194.4,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1148, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2322.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 631.4, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4258.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1148, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1148, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 918.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 918.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 344.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "BIOPSY NAIL UNIT", "code_information": [ { "code": "11755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 903,"minimum": 18.16,"maximum": 2695.55,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 75.26, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 75.26, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 82.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 75.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1482.55, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2695.55, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 808.66, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" }]}]} , { "description": "Repair of nail bed", "code_information": [ { "code": "11760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 932.5, "discounted_cash": 806,"minimum": 18.16,"maximum": 932.5,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 746, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 932.5, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 932.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 932.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 932.5, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 932.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 932.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 746, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 512.88, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 279.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 932.5, "methodology": "case rate" }]}]} , { "description": "Excision of nail fold toe", "code_information": [ { "code": "11765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 678.75, "discounted_cash": 511,"minimum": 18.16,"maximum": 678.75,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 543, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 678.75, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 55, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 678.75, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 50, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 678.75, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 373.31, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 678.75, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 50, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 678.75, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 203.63, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 543, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 50, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 678.75, "methodology": "fee schedule" }]}]} , { "description": "REMOVE PILONIDAL CYST SIMPLE", "code_information": [ { "code": "11770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11803.3, "discounted_cash": 3647,"minimum": 18.16,"maximum": 9442.6,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9442.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 690, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3540.97, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 690, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9442.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6491.79, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 759, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 690, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" }]}]} , { "description": "Remove pilonidal cyst exten", "code_information": [ { "code": "11771", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8493, "discounted_cash": 3647,"minimum": 18.16,"maximum": 6794.4,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4671.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6794.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6794.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 838, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 921.8, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 838, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 838, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2547.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" }]}]} , { "description": "REMOVE PILONIDAL CYST COMPL", "code_information": [ { "code": "11772", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11624, "discounted_cash": 3647,"minimum": 18.16,"maximum": 9299.2,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6393.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9299.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9299.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3487.2, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" }]}]} , { "description": "Rpr s/n/ax/gen/trnk 2.5cm/<", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 609.31, "discounted_cash": 256,"minimum": 18.16,"maximum": 609.31,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 182.79, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 487.45, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 526, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 609.31, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 526, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 609.31, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 578.6, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 335.12, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 526, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 609.31, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 487.45, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "RPR S/N/AX/GEN/TRNK2.6-7.5CM", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 609.31, "discounted_cash": 256,"minimum": 18.16,"maximum": 609.31,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 609.31, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 335.12, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 609.31, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 487.45, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 609.31, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 609.31, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 182.79, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 609.31, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 609.31, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 487.45, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 609.31, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" }]}]} , { "description": "Rpr s/n/ax/gen/trk7.6-12.5cm", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 643.96, "discounted_cash": 256,"minimum": 18.16,"maximum": 643.96,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 515.17, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 643.96, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 643.96, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 643.96, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 643.96, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 643.96, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 354.18, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 193.19, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 643.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 643.96, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 515.17, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" }]}]} , { "description": "RPR S/N/A/GEN/TRK12.6-20.0CM", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1899.6, "discounted_cash": 511,"minimum": 18.16,"maximum": 1899.6,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1519.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1899.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 569.88, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1899.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1519.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1899.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1044.78, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Rpr s/n/a/gen/trk20.1-30.0cm", "code_information": [ { "code": "12006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 826.88, "discounted_cash": 511,"minimum": 18.16,"maximum": 826.88,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 826.88, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 661.5, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 826.88, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 826.88, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 248.06, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 826.88, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 826.88, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 454.78, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 826.88, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 826.88, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 661.5, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "RPR S/N/AX/GEN/TRNK >30.0 CM", "code_information": [ { "code": "12007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2061, "discounted_cash": 256,"minimum": 18.16,"maximum": 2061,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1133.55, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1648.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 618.3, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2061, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1648.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2061, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" }]}]} , { "description": "MAJOR RESPIRATORY & CHEST PROCEDURES ", "code_information": [ { "code": "1201", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 18316.4,"maximum": 1.24334e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.18413e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.18413e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.24334e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.24334e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.18413e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.18413e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18316.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.18413e+008, "methodology": "case rate" }]}]} , { "description": "RPR F/E/E/N/L/M 2.6-5.0 CM", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 609.31, "discounted_cash": 256,"minimum": 18.16,"maximum": 609.31,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 609.31, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 609.31, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 335.12, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 609.31, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 487.45, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 609.31, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 609.31, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 609.31, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 487.45, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 182.79, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 609.31, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" }]}]} , { "description": "Rpr f/e/e/n/l/m 5.1-7.5 cm", "code_information": [ { "code": "12014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 648.13, "discounted_cash": 256,"minimum": 18.16,"maximum": 648.13,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 648.13, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 648.13, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 648.13, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 194.44, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 518.5, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 356.47, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 648.13, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 648.13, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 648.13, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 648.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 518.5, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" }]}]} , { "description": "RPR F/E/E/N/L/M 7.6-12.5 CM", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 820.44, "discounted_cash": 256,"minimum": 18.16,"maximum": 820.44,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 549, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 549, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 820.44, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 549, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 820.44, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 451.24, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 656.35, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 246.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 820.44, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 656.35, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 603.9, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" }]}]} , { "description": "Rpr fe/e/en/l/m 12.6-20.0 cm", "code_information": [ { "code": "12016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 868, "discounted_cash": 511,"minimum": 18.16,"maximum": 868,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 868, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 694.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 868, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 260.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 868, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 868, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 694.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 868, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 868, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 477.4, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" }]}]} , { "description": "RPR FE/E/EN/L/M 20.1-30.0 CM", "code_information": [ { "code": "12017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1463.1, "discounted_cash": 511,"minimum": 18.16,"maximum": 1463.1,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1170.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 438.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1170.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 804.71, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Rpr f/e/e/n/l/m >30.0 cm", "code_information": [ { "code": "12018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3711, "discounted_cash": 256,"minimum": 18.16,"maximum": 3425,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1113.3, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2968.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2041.05, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2968.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" }]}]} , { "description": "MAJOR RESPIRATORY & CHEST PROCEDURES ", "code_information": [ { "code": "1202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22186,"maximum": 1.55396e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 22186, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.47996e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.47996e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.47996e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.55396e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.47996e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.55396e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.47996e+008, "methodology": "case rate" }]}]} , { "description": "Tx supfc wnd dehsn smpl clsr", "code_information": [ { "code": "12020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3125, "discounted_cash": 806,"minimum": 18.16,"maximum": 3125,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 937.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1718.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3125, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2500, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2500, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "MAJOR RESPIRATORY & CHEST PROCEDURES ", "code_information": [ { "code": "1203", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 32306.8,"maximum": 2.34167e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.34167e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.23016e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.23016e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.23016e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.23016e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 32306.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.34167e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.23016e+008, "methodology": "case rate" }]}]} , { "description": "Intmd rpr s/a/t/ext 2.5 cm/<", "code_information": [ { "code": "12031", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 511,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 578.6, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 526, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 526, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 526, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" }]}]} , { "description": "INTMD RPR S/A/T/EXT 2.6-7.5", "code_information": [ { "code": "12032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 511,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" }]}]} , { "description": "Intmd rpr s/tr/ext 7.6-12.5", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 511,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "INTMD RPR S/A/T/EXT 12.6-20", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 511,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" }]}]} , { "description": "Intmd rpr s/a/t/ext 20.1-30", "code_information": [ { "code": "12036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 806,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" }]}]} , { "description": "INTMD RPR S/TR/EXT >30.0 CM", "code_information": [ { "code": "12037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12523.5, "discounted_cash": 2340,"minimum": 18.16,"maximum": 10018.8,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1980.54, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1890.51, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1872.51, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6887.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 10018.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 2160.59, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4275.11, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2520.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10018.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1440.39, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3600.98, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2790.76, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3757.03, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3673, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1854.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2700.74, "methodology": "fee schedule" }]}]} , { "description": "MAJOR RESPIRATORY & CHEST PROCEDURES ", "code_information": [ { "code": "1204", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 55710.3,"maximum": 4.42887e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.21797e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.21797e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 55710.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.21797e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.21797e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.42887e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.42887e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.21797e+008, "methodology": "case rate" }]}]} , { "description": "Intmd rpr n-hf/genit 2.5cm/<", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 871.53, "discounted_cash": 511,"minimum": 18.16,"maximum": 871.53,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 871.53, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 871.53, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 526, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 261.46, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 697.22, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 697.22, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 871.53, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 479.34, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 526, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 871.53, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 526, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 578.6, "methodology": "fee schedule" }]}]} , { "description": "INTMD RPR N-HF/GENIT2.6-7.5", "code_information": [ { "code": "12042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7533, "discounted_cash": 511,"minimum": 18.16,"maximum": 6026.4,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2259.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4143.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" }]}]} , { "description": "Intmd rpr n-hf/genit7.6-12.5", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 806,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 738, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 811.8, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 738, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 738, "methodology": "fee schedule" }]}]} , { "description": "INTMD RPR N-HF/GENIT12.6-20", "code_information": [ { "code": "12045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 806,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" }]}]} , { "description": "Intmd rpr n-hf/genit20.1-30", "code_information": [ { "code": "12046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3049, "discounted_cash": 806,"minimum": 18.16,"maximum": 3049,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2439.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 914.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1676.95, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2439.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3049, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" }]}]} , { "description": "INTMD RPR N-HF/GENIT >30.0CM", "code_information": [ { "code": "12047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7138.85, "discounted_cash": 2340,"minimum": 18.16,"maximum": 5711.08,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3926.37, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2790.76, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2520.69, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3600.98, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1440.39, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2700.74, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5711.08, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1872.51, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2141.66, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3673, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1854.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1890.51, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 2160.59, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5711.08, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1980.54, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4275.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" }]}]} , { "description": "Intmd rpr face/mm 2.5 cm/<", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 511,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 493, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 493, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 493, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 542.3, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" }]}]} , { "description": "INTMD RPR FACE/MM 2.6-5.0 CM", "code_information": [ { "code": "12052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 511,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" }]}]} , { "description": "Intmd rpr face/mm 5.1-7.5 cm", "code_information": [ { "code": "12053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 511,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" }]}]} , { "description": "INTMD RPR FACE/MM 7.6-12.5CM", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 918.44, "discounted_cash": 511,"minimum": 18.16,"maximum": 918.44,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 549, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 918.44, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 918.44, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 918.44, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 603.9, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 918.44, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 505.14, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 549, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 549, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 918.44, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 734.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 275.53, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 918.44, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 734.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Intmd rpr face/mm 12.6-20 cm", "code_information": [ { "code": "12055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 511,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" }]}]} , { "description": "INTMD RPR FACE/MM 20.1-30.0", "code_information": [ { "code": "12056", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4474, "discounted_cash": 511,"minimum": 18.16,"maximum": 3579.2,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3579.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2460.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 3579.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1342.2, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Intmd rpr face/mm >30.0 cm", "code_information": [ { "code": "12057", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5490, "discounted_cash": 511,"minimum": 18.16,"maximum": 4392,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4392, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4392, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1647, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3019.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "ACUTE MAJOR EYE INFECTIONS WITH CC/MCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5673.72,"maximum": 19931.6,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 13606.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11905.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 17574.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11338.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 15697.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 11338.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 13580.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11905.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 14861.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 11338.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16938.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 11338.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 11338.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11338.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 11338.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 5673.72, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 13580.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11678.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 19931.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 11338.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11791.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 14739.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 11338.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 12294.9, "methodology": "case rate" }]}]} , { "description": "OTHER RESPIRATORY & CHEST PROCEDURES ", "code_information": [ { "code": "1211", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12402.7,"maximum": 9.64421e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.64421e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.18496e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.18496e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.64421e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12402.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.18496e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.18496e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.18496e+007, "methodology": "case rate" }]}]} , { "description": "OTHER RESPIRATORY & CHEST PROCEDURES ", "code_information": [ { "code": "1212", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16065.5,"maximum": 1.25838e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.19845e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.19845e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.25838e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16065.5, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.19845e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.25838e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.19845e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.19845e+008, "methodology": "case rate" }]}]} , { "description": "OTHER RESPIRATORY & CHEST PROCEDURES ", "code_information": [ { "code": "1213", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 25246.4,"maximum": 2.00041e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.90515e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.90515e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.00041e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.90515e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.00041e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.90515e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.90515e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 25246.4, "methodology": "case rate" }]}]} , { "description": "OTHER RESPIRATORY & CHEST PROCEDURES ", "code_information": [ { "code": "1214", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 48252,"maximum": 3.51031e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.51031e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 48252, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.34316e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.34316e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.34316e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.51031e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.34316e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.34316e+008, "methodology": "case rate" }]}]} , { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4798.1,"maximum": 11582.2,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10429.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6930.33, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6997.62, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6728.48, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9121.61, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11582.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8324.08, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6728.48, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7064.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8074.18, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6728.48, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6728.48, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9843.03, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6728.48, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9194.57, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6728.48, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 4798.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7064.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8636.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6728.48, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8747.02, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6728.48, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6728.48, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9194.57, "methodology": "case rate" }]}]} , { "description": "NEUROLOGICAL EYE DISORDERS", "code_information": [ { "code": "123", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7239.55,"maximum": 12507.8,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7601.53, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11221.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7239.55, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10629.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9326.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7239.55, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7239.55, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7456.74, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7601.53, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7239.55, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 12507.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9850.61, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9411.42, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8853.16, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7529.13, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7718.91, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9778.98, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7239.55, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9778.98, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7239.55, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8687.46, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7239.55, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7239.55, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7239.55, "methodology": "case rate" }]}]} , { "description": "OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT", "code_information": [ { "code": "124", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7566.89,"maximum": 20564.8,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7566.89, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 12272.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 20564.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 12272.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 15350.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 11688, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 11688, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 15194.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 11688, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 12038.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 14025.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 12155.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 16955.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 11688, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 11688, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11688, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 11688, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 15334, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 11688, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 16195.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 16955.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 17476.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11688, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 18116.4, "methodology": "case rate" }]}]} , { "description": "OTHER DISORDERS OF THE EYE WITHOUT MCC", "code_information": [ { "code": "125", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6706.45,"maximum": 12406.7,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 12406.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7183.71, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10543.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11134.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7183.71, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7183.71, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7183.71, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7183.71, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7183.71, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 9496.81, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 10489.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9770.97, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7183.71, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7542.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9338.82, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6706.45, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7183.71, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7399.22, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7183.71, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9251, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 10489.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7542.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8620.45, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7471.06, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS ", "code_information": [ { "code": "1301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 27933.7,"maximum": 2.1088e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.00838e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 27933.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.1088e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.00838e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.00838e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.00838e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.1088e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.00838e+008, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS ", "code_information": [ { "code": "1302", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 30993.4,"maximum": 2.34703e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.34703e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.34703e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.23527e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.23527e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.23527e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 30993.4, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.23527e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.23527e+008, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS ", "code_information": [ { "code": "1303", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 38389.2,"maximum": 2.84665e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.7111e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.84665e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.7111e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.7111e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.7111e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 38389.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.84665e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.7111e+008, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS ", "code_information": [ { "code": "1304", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 52723.7,"maximum": 3.73139e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.5537e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.5537e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.5537e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.73139e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.5537e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 52723.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.5537e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.73139e+008, "methodology": "case rate" }]}]} , { "description": "Cmplx rpr trunk 1.1-2.5 cm", "code_information": [ { "code": "13100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2265.5, "discounted_cash": 806,"minimum": 18.16,"maximum": 2265.5,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1812.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2265.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2265.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 679.65, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1246.03, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1812.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "CMPLX RPR TRUNK 2.6-7.5 CM", "code_information": [ { "code": "13101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 806,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" }]}]} , { "description": "Cmplx rpr trunk addl 5cm/<", "code_information": [ { "code": "13102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 851.38,"minimum": 18.16,"maximum": 851.38,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 681.1, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 681.1, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 851.38, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 255.41, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 851.38, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 851.38, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 851.38, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 851.38, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 468.26, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE ", "code_information": [ { "code": "1311", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14085.8,"maximum": 9.24735e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.807e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.807e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.24735e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.807e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.807e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 14085.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.24735e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.807e+007, "methodology": "case rate" }]}]} , { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE ", "code_information": [ { "code": "1312", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 17382.3,"maximum": 1.19598e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.13903e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.13903e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.13903e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 17382.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.19598e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.13903e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.13903e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.19598e+008, "methodology": "case rate" }]}]} , { "description": "CMPLX RPR S/A/L 1.1-2.5 CM", "code_information": [ { "code": "13120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 806,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" }]}]} , { "description": "Cmplx rpr s/a/l 2.6-7.5 cm", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 806,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" }]}]} , { "description": "CMPLX RPR S/A/L ADDL 5 CM/>", "code_information": [ { "code": "13122", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 841.88,"minimum": 18.16,"maximum": 841.88,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 841.88, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 463.03, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 841.88, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 673.5, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 841.88, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 841.88, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 673.5, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 841.88, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 252.56, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE ", "code_information": [ { "code": "1313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22555.4,"maximum": 1.62135e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.54414e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.54414e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.54414e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 22555.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.62135e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.54414e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.54414e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.62135e+008, "methodology": "case rate" }]}]} , { "description": "Cmplx rpr f/c/c/m/n/ax/g/h/f", "code_information": [ { "code": "13131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 511,"minimum": 18.16,"maximum": 1786.94,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 536.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 982.82, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1786.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1429.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "CMPLX RPR F/C/C/M/N/AX/G/H/F", "code_information": [ { "code": "13132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2795.25, "discounted_cash": 806,"minimum": 18.16,"maximum": 2795.25,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1537.39, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2236.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2795.25, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2236.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 838.58, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" }]}]} , { "description": "Cmplx rpr f/c/c/m/n/ax/g/h/f", "code_information": [ { "code": "13133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562,"minimum": 18.16,"maximum": 562,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 562, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 449.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 309.1, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 562, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 562, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 449.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 562, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 562, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 168.6, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE ", "code_information": [ { "code": "1314", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 29011.3,"maximum": 2.12633e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.12633e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.02508e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 29011.3, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.02508e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.12633e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.02508e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.02508e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.02508e+008, "methodology": "case rate" }]}]} , { "description": "CMPLX RPR E/N/E/L 1.1-2.5 CM", "code_information": [ { "code": "13151", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2795.25, "discounted_cash": 806,"minimum": 18.16,"maximum": 2795.25,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2236.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1537.39, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2236.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2795.25, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 838.58, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" }]}]} , { "description": "Cmplx rpr e/n/e/l 2.6-7.5 cm", "code_information": [ { "code": "13152", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2795.25, "discounted_cash": 806,"minimum": 18.16,"maximum": 2795.25,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2236.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2236.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1537.39, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 838.58, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2795.25, "methodology": "case rate" }]}]} , { "description": "CMPLX RPR E/N/E/L ADDL 5CM/<", "code_information": [ { "code": "13153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 851.38,"minimum": 18.16,"maximum": 851.38,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 851.38, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 851.38, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 851.38, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 851.38, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 255.41, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 681.1, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 681.1, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 851.38, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 468.26, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Sec clsr surg wnd/dehsn xtn", "code_information": [ { "code": "13160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7138.85, "discounted_cash": 2340,"minimum": 18.16,"maximum": 5711.08,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4275.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1872.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3673, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2141.66, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1980.54, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1854.5, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1890.51, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3926.37, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3600.98, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5711.08, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2700.74, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2520.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5711.08, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2790.76, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1440.39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 2160.59, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 244, "methodology": "fee schedule" }]}]} , { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD ", "code_information": [ { "code": "1321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5574.4,"maximum": 2.86219e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.7259e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.7259e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.7259e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5574.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.7259e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.86219e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.7259e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.86219e+007, "methodology": "case rate" }]}]} , { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD ", "code_information": [ { "code": "1322", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6226.44,"maximum": 4.41402e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6226.44, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.20383e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.41402e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.20383e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.41402e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.20383e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.20383e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.20383e+007, "methodology": "case rate" }]}]} , { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD ", "code_information": [ { "code": "1323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9624.1,"maximum": 8.30078e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.30078e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.90551e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.30078e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9624.1, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.90551e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.90551e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.90551e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.90551e+007, "methodology": "case rate" }]}]} , { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD ", "code_information": [ { "code": "1324", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16022.9,"maximum": 1.23161e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.23161e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.17296e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.17296e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.17296e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.23161e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.17296e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16022.9, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.17296e+008, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY FAILURE ", "code_information": [ { "code": "1331", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4143.49,"maximum": 2.93956e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4143.49, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.93956e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.79958e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.79958e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.93956e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.79958e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.79958e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.79958e+007, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY FAILURE ", "code_information": [ { "code": "1332", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7247.22,"maximum": 5.06795e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.82662e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.82662e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7247.22, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.82662e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.82662e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.06795e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.06795e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.82662e+007, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY FAILURE ", "code_information": [ { "code": "1333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11010.4,"maximum": 7.81283e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.44079e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.44079e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.44079e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.44079e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11010.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.44079e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.81283e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.81283e+007, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY FAILURE ", "code_information": [ { "code": "1334", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20056.1,"maximum": 1.34274e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.2788e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.2788e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.2788e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.34274e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20056.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.34274e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.2788e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.2788e+008, "methodology": "case rate" }]}]} , { "description": "PULMONARY EMBOLISM ", "code_information": [ { "code": "1341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6585.84,"maximum": 3.95166e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.95166e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.95166e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.76348e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.76348e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.76348e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6585.84, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.76348e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.76348e+007, "methodology": "case rate" }]}]} , { "description": "PULMONARY EMBOLISM ", "code_information": [ { "code": "1342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8544.76,"maximum": 5.18463e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.18463e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.18463e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.93775e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.93775e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.93775e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.93775e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.93775e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8544.76, "methodology": "case rate" }]}]} , { "description": "PULMONARY EMBOLISM ", "code_information": [ { "code": "1343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12473,"maximum": 8.0019e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.62086e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.62086e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.0019e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.62086e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.0019e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.62086e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12473, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.62086e+007, "methodology": "case rate" }]}]} , { "description": "PULMONARY EMBOLISM ", "code_information": [ { "code": "1344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21644,"maximum": 1.34442e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.2804e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.34442e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.34442e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.2804e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.2804e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.2804e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 21644, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.2804e+008, "methodology": "case rate" }]}]} , { "description": "SINUS AND MASTOID PROCEDURES WITH CC/MCC", "code_information": [ { "code": "135", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10140.7,"maximum": 41258.7,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 23113.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 26211.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 30047.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 32493.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 28952.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 35063.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 23113.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 24038.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 30764.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 27736.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 23113.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 10140.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 24269.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 23113.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 23113.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 23113.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 35826.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 23113.6, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 24269.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 23113.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 41258.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 23807, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 23113.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 28952.6, "methodology": "case rate" }]}]} , { "description": "MAJOR CHEST & RESPIRATORY TRAUMA ", "code_information": [ { "code": "1351", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6901.41,"maximum": 5.38618e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.1297e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6901.41, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.38618e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.38618e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.1297e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.1297e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.1297e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.1297e+007, "methodology": "case rate" }]}]} , { "description": "MAJOR CHEST & RESPIRATORY TRAUMA ", "code_information": [ { "code": "1352", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8653.09,"maximum": 6.1961e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8653.09, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.90105e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.1961e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.90105e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.90105e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.90105e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.1961e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.90105e+007, "methodology": "case rate" }]}]} , { "description": "MAJOR CHEST & RESPIRATORY TRAUMA ", "code_information": [ { "code": "1353", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12629,"maximum": 8.89606e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.47244e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.89606e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.47244e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.89606e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.47244e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.47244e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.47244e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12629, "methodology": "case rate" }]}]} , { "description": "MAJOR CHEST & RESPIRATORY TRAUMA ", "code_information": [ { "code": "1354", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23820.5,"maximum": 1.55477e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.48073e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.48073e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.48073e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.48073e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.55477e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.55477e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.48073e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 23820.5, "methodology": "case rate" }]}]} , { "description": "SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "136", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9303.57,"maximum": 15481.5,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 14015.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14609.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9675.71, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11164.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9303.57, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 14103.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9768.75, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9582.68, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9303.57, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9303.57, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 9768.75, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9303.57, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11505.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9303.57, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 15481.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9303.57, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 15481.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9303.57, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12415.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 12094.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9303.57, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 14420.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9303.57, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10893.6, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY MALIGNANCY ", "code_information": [ { "code": "1361", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7066.5,"maximum": 5.27511e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.02392e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.02392e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.02392e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.27511e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.02392e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.02392e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.27511e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7066.5, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY MALIGNANCY ", "code_information": [ { "code": "1362", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8977.64,"maximum": 6.71588e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.39607e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.39607e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.71588e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.39607e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.39607e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.71588e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8977.64, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.39607e+007, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY MALIGNANCY ", "code_information": [ { "code": "1363", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13578.7,"maximum": 9.59741e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.59741e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 13578.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.14039e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.14039e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.14039e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.14039e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.14039e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.59741e+007, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY MALIGNANCY ", "code_information": [ { "code": "1364", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22016.6,"maximum": 1.46916e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.3992e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.46916e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 22016.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.3992e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.3992e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.3992e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.46916e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.3992e+008, "methodology": "case rate" }]}]} , { "description": "MOUTH PROCEDURES WITH CC/MCC", "code_information": [ { "code": "137", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8577.71,"maximum": 23408.6,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13258.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 15864.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 13788.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 17523.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 13921, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 19893.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8577.71, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13258.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13258.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 17454.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13258.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 23408.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13258.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13258.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 13655.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 20550.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13258.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 18435.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13258.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13258.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 15909.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 17235.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 13921, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 17523.8, "methodology": "case rate" }]}]} , { "description": "MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS ", "code_information": [ { "code": "1371", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6460.85,"maximum": 4.22059e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.01961e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.01961e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6460.85, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.01961e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.22059e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.01961e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.01961e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.22059e+007, "methodology": "case rate" }]}]} , { "description": "MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS ", "code_information": [ { "code": "1372", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8348.28,"maximum": 5.40303e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8348.28, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.14574e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.14574e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.40303e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.14574e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.40303e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.14574e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.14574e+007, "methodology": "case rate" }]}]} , { "description": "MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS ", "code_information": [ { "code": "1373", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12400.2,"maximum": 7.21755e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.87386e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.21755e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.87386e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.87386e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.87386e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.21755e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.87386e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12400.2, "methodology": "case rate" }]}]} , { "description": "MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS ", "code_information": [ { "code": "1374", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20993.4,"maximum": 1.3604e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.29562e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.3604e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.29562e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.3604e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20993.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.29562e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.29562e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.29562e+008, "methodology": "case rate" }]}]} , { "description": "MOUTH PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "138", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7769.52,"maximum": 13467.7,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10100.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7769.52, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7769.52, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8158, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7769.52, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 9889.96, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 9554.37, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9323.42, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7769.52, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7769.52, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8158, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11445.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7769.52, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8080.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7769.52, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 10924.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 13467.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 12042.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7769.52, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 10924.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8002.61, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7769.52, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10042.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10606.6, "methodology": "case rate" }]}]} , { "description": "BRONCHIOLITIS & RSV PNEUMONIA ", "code_information": [ { "code": "1381", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3002.33,"maximum": 2.36301e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.25048e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.25048e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.36301e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.36301e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.25048e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.25048e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 3002.33, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.25048e+007, "methodology": "case rate" }]}]} , { "description": "BRONCHIOLITIS & RSV PNEUMONIA ", "code_information": [ { "code": "1382", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4544.39,"maximum": 3.43251e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4544.39, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.26905e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.26905e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.43251e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.26905e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.26905e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.26905e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.43251e+007, "methodology": "case rate" }]}]} , { "description": "BRONCHIOLITIS & RSV PNEUMONIA ", "code_information": [ { "code": "1383", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10877.5,"maximum": 5.69255e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.42148e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10877.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.42148e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.69255e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.69255e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.42148e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.42148e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.42148e+007, "methodology": "case rate" }]}]} , { "description": "BRONCHIOLITIS & RSV PNEUMONIA ", "code_information": [ { "code": "1384", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 27044,"maximum": 1.40239e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.33561e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.33561e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.33561e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 27044, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.33561e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.40239e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.40239e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.33561e+008, "methodology": "case rate" }]}]} , { "description": "SALIVARY GLAND PROCEDURES", "code_information": [ { "code": "139", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10535.3,"maximum": 18477,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 13695.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 10956.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10535.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 13777.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11062.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 16329.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10535.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 11645.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 12642.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10535.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10535.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 10851.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 14835.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10535.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 18477, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10535.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10535.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 15702.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10535.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14551.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 13430.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 14835.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10535.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11062.1, "methodology": "case rate" }]}]} , { "description": "OTHER PNEUMONIA ", "code_information": [ { "code": "1391", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4412.49,"maximum": 3.22597e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.07235e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.07235e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.22597e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.07235e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.22597e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4412.49, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.07235e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.07235e+007, "methodology": "case rate" }]}]} , { "description": "OTHER PNEUMONIA ", "code_information": [ { "code": "1392", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6197.61,"maximum": 4.2312e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.02971e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.2312e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.02971e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.2312e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.02971e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6197.61, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.02971e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.02971e+007, "methodology": "case rate" }]}]} , { "description": "OTHER PNEUMONIA ", "code_information": [ { "code": "1393", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9738.01,"maximum": 6.36333e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9738.01, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.06031e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.06031e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.06031e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.36333e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.36333e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.06031e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.06031e+007, "methodology": "case rate" }]}]} , { "description": "OTHER PNEUMONIA ", "code_information": [ { "code": "1394", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 18733.3,"maximum": 1.15617e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.10111e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.10111e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.10111e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.10111e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.15617e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18733.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.15617e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.10111e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [ { "code": "140", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11226.6,"maximum": 58775.9,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 32785.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 34096.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 34424.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 42620.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 32785.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 32785.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 49950.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 32785.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 33768.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 39342.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 34424.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 32785.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 43826, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 46289.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 32785.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 50817.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 32785.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 32785.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 11226.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 58775.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 32785.3, "methodology": "case rate" }]}]} , { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE ", "code_information": [ { "code": "1401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5113.4,"maximum": 3.5885e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5113.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.41762e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.41762e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.41762e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.41762e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.5885e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.5885e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.41762e+007, "methodology": "case rate" }]}]} , { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE ", "code_information": [ { "code": "1402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6384.36,"maximum": 4.51261e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.29772e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.51261e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.29772e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.29772e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.29772e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.29772e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6384.36, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.51261e+007, "methodology": "case rate" }]}]} , { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE ", "code_information": [ { "code": "1403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8714.08,"maximum": 5.66697e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.39711e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.66697e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8714.08, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.39711e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.39711e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.39711e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.39711e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.66697e+007, "methodology": "case rate" }]}]} , { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE ", "code_information": [ { "code": "1404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16930.4,"maximum": 1.1017e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.1017e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.1017e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.04923e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16930.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.04923e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.04923e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.04923e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.04923e+008, "methodology": "case rate" }]}]} , { "description": "Tis trnfr f/c/c/m/n/a/g/h/f", "code_information": [ { "code": "14040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1716, "discounted_cash": 2340,"minimum": 18.16,"maximum": 1716,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 177.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 807, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1716, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1716, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 807, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 807, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1372.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1716, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 887.7, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1372.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 514.8, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1716, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1440.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1716, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 943.8, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Tis trnfr e/n/e/l 10 sq cm/<", "code_information": [ { "code": "14060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8576.8, "discounted_cash": 2340,"minimum": 18.16,"maximum": 6861.44,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3600.98, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1440.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4717.24, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1872.51, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1980.54, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 2160.59, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1890.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 980.1, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 891, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 891, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 891, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2573.04, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2700.74, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1854.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4275.11, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6861.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3673, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2790.76, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6861.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2520.69, "methodology": "fee schedule" }]}]} , { "description": "MAJOR HEAD AND NECK PROCEDURES WITH CC", "code_information": [ { "code": "141", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13157.5,"maximum": 32229.4,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 18128.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 18853.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 28098.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 13157.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 18128.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 18128.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 18128.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 18128.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 19034.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 18128.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 25382.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 18128.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 18672.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 23566.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 18128.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 32229.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 21754, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 19034.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 24031.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 27390, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 18128.3, "methodology": "case rate" }]}]} , { "description": "ASTHMA ", "code_information": [ { "code": "1411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3917.15,"maximum": 3.13612e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.98678e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.13612e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.98678e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.98678e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.98678e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 3917.15, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.13612e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.98678e+007, "methodology": "case rate" }]}]} , { "description": "ASTHMA ", "code_information": [ { "code": "1412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5614.25,"maximum": 4.49327e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.2793e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.49327e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.2793e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.2793e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.2793e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.2793e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.49327e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5614.25, "methodology": "case rate" }]}]} , { "description": "ASTHMA ", "code_information": [ { "code": "1413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8046.16,"maximum": 5.18214e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.93537e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.93537e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.93537e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8046.16, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.18214e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.93537e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.93537e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.18214e+007, "methodology": "case rate" }]}]} , { "description": "ASTHMA ", "code_information": [ { "code": "1414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15212.8,"maximum": 1.05109e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.00104e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.00104e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.00104e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.00104e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.00104e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15212.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.05109e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.05109e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "142", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13604.3,"maximum": 24035.6,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13604.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 17685.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 20426.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14148.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 24035.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 16325.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13604.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 21086.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13604.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 14012.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13604.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13604.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13604.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13604.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13604.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 18929.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14284.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 14284.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 15759.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 17922, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13604.3, "methodology": "case rate" }]}]} , { "description": "INTERSTITIAL & ALVEOLAR LUNG DISEASES ", "code_information": [ { "code": "1421", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6561.81,"maximum": 4.67173e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.44926e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.44926e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.67173e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6561.81, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.44926e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.44926e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.44926e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.67173e+007, "methodology": "case rate" }]}]} , { "description": "INTERSTITIAL & ALVEOLAR LUNG DISEASES ", "code_information": [ { "code": "1422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7980.37,"maximum": 5.54093e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.54093e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.27707e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.54093e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.27707e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.27707e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.27707e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7980.37, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.27707e+007, "methodology": "case rate" }]}]} , { "description": "INTERSTITIAL & ALVEOLAR LUNG DISEASES ", "code_information": [ { "code": "1423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11547.4,"maximum": 8.40935e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.00891e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.40935e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.00891e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.00891e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.00891e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11547.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.40935e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.00891e+007, "methodology": "case rate" }]}]} , { "description": "INTERSTITIAL & ALVEOLAR LUNG DISEASES ", "code_information": [ { "code": "1424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20435.7,"maximum": 1.50235e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.50235e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.43081e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20435.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.43081e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.43081e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.43081e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.50235e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.43081e+008, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "143", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10638.1,"maximum": 51736.4,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 38577, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 28898.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 28898.6, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 37568.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 30343.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 10638.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 28898.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 44792.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 30054.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 28898.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 30343.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 28898.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 43967.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 28898.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 28898.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 28898.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 28898.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 40745.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 34678.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 29765.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 51736.4, "methodology": "case rate" }]}]} , { "description": "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES", "code_information": [ { "code": "1431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4877.91,"maximum": 3.87428e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.68979e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.68979e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4877.91, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.68979e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.87428e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.68979e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.87428e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.68979e+007, "methodology": "case rate" }]}]} , { "description": "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES", "code_information": [ { "code": "1432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7160.48,"maximum": 5.53156e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.26816e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7160.48, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.26816e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.26816e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.53156e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.26816e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.26816e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.53156e+007, "methodology": "case rate" }]}]} , { "description": "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES", "code_information": [ { "code": "1433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11020.8,"maximum": 8.57533e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.16698e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.57533e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11020.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.16698e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.57533e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.16698e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.16698e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.16698e+007, "methodology": "case rate" }]}]} , { "description": "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES", "code_information": [ { "code": "1434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 18780.7,"maximum": 1.43284e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.43284e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.36461e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.36461e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.36461e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.43284e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18780.7, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.36461e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.36461e+008, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "144", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11729.1,"maximum": 26921.4,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 15957.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 21202.1, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15197.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 18237.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 15653.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 15197.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 26921.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 15197.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 15957.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 15197.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 20073.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 15197.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 11729.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 19756.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 15197.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22878.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15197.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 15197.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 15197.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 15805.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 23556.3, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES", "code_information": [ { "code": "1441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4777.97,"maximum": 3.94105e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.75338e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.75338e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4777.97, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.75338e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.75338e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.94105e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.75338e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.94105e+007, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES", "code_information": [ { "code": "1442", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5786.33,"maximum": 5.14346e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.89853e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.89853e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.89853e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.89853e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.14346e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.14346e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5786.33, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.89853e+007, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES", "code_information": [ { "code": "1443", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8178.71,"maximum": 7.79286e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.42177e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.42177e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.42177e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.79286e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.42177e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.42177e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8178.71, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.79286e+007, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES", "code_information": [ { "code": "1444", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14345.3,"maximum": 1.41481e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.34744e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.34744e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.34744e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.34744e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 14345.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.41481e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.34744e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.41481e+008, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "145", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10822.2,"maximum": 18996.7,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10822.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10822.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14960.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11146.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11363.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 18996.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11255.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10822.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10822.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10822.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 12986.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 13049.6, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 14068.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16144.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10822.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 16774.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10822.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11363.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 14164.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10822.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10822.2, "methodology": "case rate" }]}]} , { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS ", "code_information": [ { "code": "1451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3.49844e+007,"maximum": 3.67336e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.67336e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.49844e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.49844e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.67336e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.49844e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.49844e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.49844e+007, "methodology": "case rate" }]}]} , { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS ", "code_information": [ { "code": "1452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4.34705e+007,"maximum": 4.5644e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.34705e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.34705e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.34705e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.5644e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.5644e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.34705e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.34705e+007, "methodology": "case rate" }]}]} , { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS ", "code_information": [ { "code": "1453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5.66572e+007,"maximum": 5.94901e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.94901e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.66572e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.66572e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.66572e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.66572e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.94901e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.66572e+007, "methodology": "case rate" }]}]} , { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS ", "code_information": [ { "code": "1454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.01976e+008,"maximum": 1.07075e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.01976e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.01976e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.07075e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.07075e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.01976e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.01976e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.01976e+008, "methodology": "case rate" }]}]} , { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7254.1,"maximum": 32840.8,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 18465.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 24487.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 19019.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 24298.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 18465.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 24005.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 18465.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 24298.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 19389.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 27909.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 18465.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 19389.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7254.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 21998, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 19204.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 25864, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 28622.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 22159.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 18465.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 18465.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 32840.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 18465.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 18465.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 18465.9, "methodology": "case rate" }]}]} , { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6729.56,"maximum": 19225.3,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10948.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 15953, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11495.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11495.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 14442.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10948.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10948.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6729.56, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 16970.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16338.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10948.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 13138.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 19225.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 14335.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10948.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10948.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 14233, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11276.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10948.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11386.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 15141, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10948.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 15953, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10948.5, "methodology": "case rate" }]}]} , { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7227.58,"maximum": 13841.1,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10320.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7975.67, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8294.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7975.67, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7227.58, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8214.94, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10900.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7975.67, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11762.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8374.45, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7975.67, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8526.28, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 12362.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7975.67, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7975.67, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9417.91, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9570.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7975.67, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10368.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7975.67, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7975.67, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8374.45, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9417.91, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 13841.1, "methodology": "case rate" }]}]} , { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6730.2,"maximum": 11585.3,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8638.52, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7728.02, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9260.34, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8749.26, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11585.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9845.68, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6932.11, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9124.06, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7066.71, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9260.34, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6999.41, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8076.24, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8383.62, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10431.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7066.71, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6730.2, "methodology": "case rate" }]}]} , { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7664.18,"maximum": 20449.7,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 11624.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 15248.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 11624.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 13949.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 11624.4, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11973.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 12205.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 18017.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11624.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 11624.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 12089.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 15307.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 11624.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 16908.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 12205.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11624.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 20449.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 15111.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 16105.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 11624.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 11624.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7664.18, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 17379, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 16908.4, "methodology": "case rate" }]}]} , { "description": "Wound prep trk/arm/leg", "code_information": [ { "code": "15002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1441.5, "discounted_cash": 2340,"minimum": 18.16,"maximum": 1441.5,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 792.83, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 432.45, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1441.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1441.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1441.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1441.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1441.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1153.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1153.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1440.39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" }]}]} , { "description": "WOUND PREP ADDL 100 CM", "code_information": [ { "code": "15003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64,"minimum": 12.06,"maximum": 64,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 35.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 35.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 51.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 51.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 35.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 64, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 64, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12.06, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 19.2, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 64, "methodology": "case rate" }]}]} , { "description": "Wound prep f/n/hf/g", "code_information": [ { "code": "15004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1441.5, "discounted_cash": 806,"minimum": 18.16,"maximum": 1441.5,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 432.45, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 792.83, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1441.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1441.5, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 792.83, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1153.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1441.5, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 792.83, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1153.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1441.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" }]}]} , { "description": "WND PREP F/N/HF/G ADDL CM", "code_information": [ { "code": "15005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204,"minimum": 18.16,"maximum": 204,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 204, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 204, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 163.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 112.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 61.2, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 163.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 112.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 112.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 204, "methodology": "case rate" }]}]} , { "description": "Pinch graft up to 2 cm diam", "code_information": [ { "code": "15050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2265.5, "discounted_cash": 806,"minimum": 18.16,"maximum": 2265.5,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 638.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 679.65, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1812.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 930.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1812.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1246.03, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2265.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 682.09, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 961.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 744.1, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 496.06, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 644.88, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1264.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 868.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1472.33, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 620.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 651.08, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1240.16, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2265.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 620.08, "methodology": "fee schedule" }]}]} , { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6815.64,"maximum": 11989.8,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9039.58, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9169.76, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6953.52, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6953.52, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6953.52, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7301.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6953.52, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6815.64, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6953.52, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8344.22, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8940.12, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6953.52, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6953.52, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8301.62, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11989.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10778, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6953.52, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6953.52, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10189.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9442.62, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7231.66, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9169.76, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7301.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7162.13, "methodology": "case rate" }]}]} , { "description": "SKIN SPLT GRFT T/A/L ADD-ON", "code_information": [ { "code": "15101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2925,"minimum": 18.16,"maximum": 2925,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 877.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2925, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2340, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1608.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2340, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" }]}]} , { "description": "Epidrm autogrft trnk/arm/leg", "code_information": [ { "code": "15110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7138.85, "discounted_cash": 2340,"minimum": 18.16,"maximum": 5711.08,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5711.08, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3673, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1890.51, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2141.66, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1980.54, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5711.08, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3926.37, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1440.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2700.74, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4275.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1872.51, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2790.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 2160.59, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3600.98, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2520.69, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1854.5, "methodology": "fee schedule" }]}]} , { "description": "EPIDRM AUTOGRFT T/A/L ADD-ON", "code_information": [ { "code": "15111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2630.25,"minimum": 18.16,"maximum": 2630.25,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 789.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2630.25, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1446.64, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Epidrm a-grft face/nck/hf/g", "code_information": [ { "code": "15115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7138.85, "discounted_cash": 2340,"minimum": 18.16,"maximum": 5711.08,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1440.39, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2790.76, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3600.98, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1890.51, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3926.37, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2700.74, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2141.66, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5711.08, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1854.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1872.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3673, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4275.11, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5711.08, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 2160.59, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1980.54, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2520.69, "methodology": "fee schedule" }]}]} , { "description": "EPIDRM A-GRFT F/N/HF/G ADDL", "code_information": [ { "code": "15116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1501.19,"minimum": 18.16,"maximum": 1501.19,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1501.19, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 825.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1501.19, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1501.19, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 450.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1501.19, "methodology": "case rate" }]}]} , { "description": "Skn splt a-grft fac/nck/hf/g", "code_information": [ { "code": "15120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12523.5, "discounted_cash": 4604,"minimum": 18.16,"maximum": 10018.8,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4958.98, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 565, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 7225.95, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 621.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 4250.56, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2833.7, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 565, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 565, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3683.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 5313.19, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6887.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 5490.3, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3896.34, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10018.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 7084.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3757.03, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 8410.48, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3719.24, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3648.39, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 10018.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "SKN SPLT A-GRFT F/N/HF/G ADD", "code_information": [ { "code": "15121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302,"minimum": 18.16,"maximum": 302,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 166.1, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 302, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 90.6, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 241.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 302, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 302, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 241.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 302, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 302, "methodology": "case rate" }]}]} , { "description": "OTITIS MEDIA AND URI WITH MCC", "code_information": [ { "code": "152", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6850.84,"maximum": 18484.8,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14557.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 10961.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 10855.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 13367.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10539.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 12647.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 12101.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 13701.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11066.6, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10539.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10539.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 18484.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 16336.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 13783.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 13367.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10539.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6850.84, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10539.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10539.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10539.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11066.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10539.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 15709.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10539.6, "methodology": "case rate" }]}]} , { "description": "Skin sub graft trnk/arm/leg", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5975.75, "discounted_cash": 2340,"minimum": 18.16,"maximum": 4780.6,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1890.51, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1980.54, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3673, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1872.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1854.5, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1440.39, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2790.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1792.72, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4780.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 2160.59, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4275.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3600.98, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2700.74, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3286.66, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2520.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4780.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" }]}]} , { "description": "SKIN SUB GRAFT T/A/L ADD-ON", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 560.5,"minimum": 18.16,"maximum": 560.5,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 560.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 448.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 168.15, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 448.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 560.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 560.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 560.5, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 308.27, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 560.5, "methodology": "case rate" }]}]} , { "description": "Skin sub grft t/arm/lg child", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2316.51, "discounted_cash": 4604,"minimum": 18.16,"maximum": 2316.51,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2316.51, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1853.21, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2316.51, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 694.95, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1853.21, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1274.08, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" }]}]} , { "description": "SKN SUB GRFT T/A/L CHILD ADD", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1521.14,"minimum": 18.16,"maximum": 1521.14,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1521.14, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1521.14, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1521.14, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1216.91, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1521.14, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 456.34, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1216.91, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 836.63, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Skin sub graft face/nk/hf/g", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5975.75, "discounted_cash": 2340,"minimum": 18.16,"maximum": 4780.6,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4780.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 2160.59, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1792.72, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3600.98, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3286.66, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3673, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1854.5, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4275.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1980.54, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2520.69, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2790.76, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1440.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4780.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1890.51, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1872.51, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2700.74, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "SKIN SUB GRAFT F/N/HF/G ADDL", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 560.5,"minimum": 18.16,"maximum": 560.5,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 560.5, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 168.15, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 448.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 308.27, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 448.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 560.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 560.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 560.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 560.5, "methodology": "case rate" }]}]} , { "description": "Skn sub grft f/n/hf/g child", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2316.51, "discounted_cash": 2340,"minimum": 18.16,"maximum": 2316.51,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2316.51, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 694.95, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1853.21, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1440.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2316.51, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 2160.59, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1854.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1890.51, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1853.21, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1274.08, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1980.54, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1872.51, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2316.51, "methodology": "fee schedule" }]}]} , { "description": "SKN SUB GRFT F/N/HF/G CH ADD", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1521.14,"minimum": 18.16,"maximum": 1521.14,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1521.14, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1216.91, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1216.91, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 456.34, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 836.63, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1521.14, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1521.14, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1521.14, "methodology": "case rate" }]}]} , { "description": "OTITIS MEDIA AND URI WITHOUT MCC", "code_information": [ { "code": "153", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6104.02,"maximum": 11431.3,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6645.16, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6977.42, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6977.42, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9714.79, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6645.16, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6910.97, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6645.16, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9002.77, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6645.16, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7974.19, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6645.16, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6104.02, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6645.16, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11431.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6844.51, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9269.02, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9269.02, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10300, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6645.16, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8638.71, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8391.48, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6645.16, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6645.16, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8523.68, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC", "code_information": [ { "code": "154", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7307.1,"maximum": 23929.8,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 18846, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13545.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 23929.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 20996.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 20336.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 18384.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13545.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13545.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7307.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13545.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13545.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13545.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 17843.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 16644.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13545.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14087.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 18384.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 17609.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13545.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14223.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13545.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 14223.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 13952.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 16255.1, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC", "code_information": [ { "code": "155", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6385.2,"maximum": 14726.3,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8464.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12515, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8464.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8464.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8464.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11396.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8802.98, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8464.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6385.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8887.62, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11396.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11003.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8464.4, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8718.33, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 13119.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10157.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8887.62, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8464.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14726.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10980.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11597.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8464.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10317.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8464.4, "methodology": "case rate" }]}]} , { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC", "code_information": [ { "code": "156", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5964.03,"maximum": 10197.6,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 7808.49, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 5964.03, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 5964.03, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 8625.06, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 5964.03, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 7603.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7156.84, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6142.95, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6313.19, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 8666.37, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 8625.06, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 5964.03, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 5964.03, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 7753.24, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 5964.03, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9244.25, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6262.23, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 10197.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6202.59, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 5964.03, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 8031.19, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 5964.03, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 5964.03, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6262.23, "methodology": "case rate" }]}]} , { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7389.36,"maximum": 26555.8,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 19801.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 15745.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 14995.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 14995.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 15745.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 14995.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 21195.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 14995.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 26555.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20914.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 17994.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 23243.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 14995.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 14995.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22568.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 14995.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 14995.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 19188.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 15595.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 21195.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 15445.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7389.36, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 19494.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 14995.8, "methodology": "case rate" }]}]} , { "description": "Abrasion lesion single", "code_information": [ { "code": "15786", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 765.6, "discounted_cash": 256,"minimum": 18.16,"maximum": 765.6,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 421.08, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 765.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 229.68, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 765.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 612.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 765.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 612.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" }]}]} , { "description": "ABRASION LESIONS ADD-ON", "code_information": [ { "code": "15787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.75,"minimum": 18.16,"maximum": 429.75,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 343.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 429.75, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 236.36, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 429.75, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 429.75, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 343.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 128.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 429.75, "methodology": "case rate" }]}]} , { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6453.26,"maximum": 14600.2,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10396.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11483.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6453.26, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 13012, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8394.83, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8394.83, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10073.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11498.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8394.83, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8646.67, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8814.57, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10886.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12407.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8394.83, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8394.83, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8394.83, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8730.62, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10913.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8394.83, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8394.83, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8814.57, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14600.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8394.83, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11483.8, "methodology": "case rate" }]}]} , { "description": "Exc skin abd", "code_information": [ { "code": "15830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12243, "discounted_cash": 8369,"minimum": 18.16,"maximum": 12243,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9794.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 12243, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6733.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6631.55, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12243, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9657.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9794.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 12243, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7726.08, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6695.94, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7082.24, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5150.72, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6760.32, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9013.76, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9979.52, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3672.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Suction lipectomy trunk", "code_information": [ { "code": "15877", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25743, "discounted_cash": 4604,"minimum": 18.16,"maximum": 20594.4,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7722.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3896.34, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 4250.56, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3719.24, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4958.98, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 5490.3, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 20594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 5313.19, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 14158.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 8410.48, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3683.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2833.7, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 7084.26, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3648.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 7225.95, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3542.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" }]}]} , { "description": "DENTAL AND ORAL DISEASES WITHOUT CC/MCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6133.23,"maximum": 10504.1,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 7973.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6133.23, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6133.23, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6133.23, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7359.88, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6133.23, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 7832.32, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6439.89, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6378.56, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6629.12, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9506.51, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6133.23, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6439.89, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6133.23, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 10504.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 8854.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6133.23, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6317.23, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6133.23, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 8854.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6133.23, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8016.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 8272.55, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 8926.82, "methodology": "case rate" }]}]} , { "description": "INITIAL TREATMENT OF BURN(S)", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.2, "discounted_cash": 256,"minimum": 18,"maximum": 420.2,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 420.2, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 126.06, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 18, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 336.16, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 420.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 336.16, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 19.8, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 420.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 18, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 231.11, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 420.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 420.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 420.2, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 18, "methodology": "fee schedule" }]}]} , { "description": "MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY ", "code_information": [ { "code": "1601", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 30656.2,"maximum": 2.05233e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.9546e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.05233e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.9546e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.05233e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.9546e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.9546e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.9546e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 30656.2, "methodology": "case rate" }]}]} , { "description": "MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY ", "code_information": [ { "code": "1602", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 35764.6,"maximum": 2.60991e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.48563e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.48563e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 35764.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.60991e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.48563e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.48563e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.48563e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.60991e+008, "methodology": "case rate" }]}]} , { "description": "Dress/debrid p-thick burn s", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 760, "discounted_cash": 256,"minimum": 18.16,"maximum": 760,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 608, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 760, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 760, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 760, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 608, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 418, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 22, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 228, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" }]}]} , { "description": "DRESS/DEBRID P-THICK BURN M", "code_information": [ { "code": "16025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 760, "discounted_cash": 256,"minimum": 18.16,"maximum": 760,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 608, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 418, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 100.55, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 760, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 760, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 760, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 228, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 110.61, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 608, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 100.55, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 100.55, "methodology": "fee schedule" }]}]} , { "description": "MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY ", "code_information": [ { "code": "1603", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 54152.6,"maximum": 4.17267e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.17267e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.97397e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.97397e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.97397e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.97397e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.97397e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 54152.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.17267e+008, "methodology": "case rate" }]}]} , { "description": "Dress/debrid p-thick burn l", "code_information": [ { "code": "16030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 578.75, "discounted_cash": 511,"minimum": 18.16,"maximum": 578.75,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 463, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 463, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 173.63, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 578.75, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 115.08, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 578.75, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 578.75, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 578.75, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 578.75, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 115.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 578.75, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 318.31, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 578.75, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 578.75, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 115.08, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 126.59, "methodology": "fee schedule" }]}]} , { "description": "INCISION OF BURN SCAB INITI", "code_information": [ { "code": "16035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1463.1, "discounted_cash": 511,"minimum": 18.16,"maximum": 1463.1,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 438.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 340, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 340, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 340, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1170.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1170.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY ", "code_information": [ { "code": "1604", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 120600,"maximum": 1.03026e+009,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.81197e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.81197e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 120600, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.81197e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.81197e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.81197e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.03026e+009, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.03026e+009, "methodology": "case rate" }]}]} , { "description": "IMPLANTABLE HEART ASSIST SYSTEMS", "code_information": [ { "code": "1611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 41503.3,"maximum": 9.13797e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.70283e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.13797e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.70283e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.13797e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 41503.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.70283e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.70283e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.70283e+008, "methodology": "case rate" }]}]} , { "description": "IMPLANTABLE HEART ASSIST SYSTEMS", "code_information": [ { "code": "1612", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 53580.6,"maximum": 9.59104e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.13433e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.59104e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.13433e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.13433e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.59104e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 53580.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.13433e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.13433e+008, "methodology": "case rate" }]}]} , { "description": "IMPLANTABLE HEART ASSIST SYSTEMS", "code_information": [ { "code": "1613", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 86171.7,"maximum": 1.19482e+009,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.19482e+009, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.13792e+009, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.13792e+009, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.19482e+009, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.13792e+009, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.13792e+009, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 86171.7, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.13792e+009, "methodology": "case rate" }]}]} , { "description": "IMPLANTABLE HEART ASSIST SYSTEMS", "code_information": [ { "code": "1614", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 206769,"maximum": 1.76585e+009,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.68176e+009, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.76585e+009, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.68176e+009, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 206769, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.68176e+009, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.68176e+009, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.76585e+009, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.68176e+009, "methodology": "case rate" }]}]} , { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX ", "code_information": [ { "code": "1621", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 44467.8,"maximum": 2.87473e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.73784e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 44467.8, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.73784e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.73784e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.73784e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.73784e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.87473e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.87473e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX ", "code_information": [ { "code": "1622", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 49353.9,"maximum": 3.34209e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.18294e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.18294e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.18294e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 49353.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.34209e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.18294e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.34209e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.18294e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX ", "code_information": [ { "code": "1623", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 65316.5,"maximum": 4.4932e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.27924e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 65316.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.4932e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.4932e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.27924e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.27924e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.27924e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.27924e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX ", "code_information": [ { "code": "1624", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 102733,"maximum": 7.03336e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.69844e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 102733, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.69844e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.69844e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.03336e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.69844e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.03336e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.69844e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR CHEST PROCEDURES WITH MCC", "code_information": [ { "code": "163", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11629.7,"maximum": 73329.5,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 42861.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 62318.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 40820.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 53066.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 11629.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 40820.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 40820.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 42861.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 40820.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 61474.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 40820.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 73329.5, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 42045.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 63272, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 54677.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 61474.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 40820.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 40820.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 40820.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 40820.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 55654.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 42453.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 57751, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 48984.8, "methodology": "case rate" }]}]} , { "description": "CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX ", "code_information": [ { "code": "1631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 36692.6,"maximum": 2.46315e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.46315e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.34586e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 36692.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.34586e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.46315e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.34586e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.34586e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.34586e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX ", "code_information": [ { "code": "1632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 42160,"maximum": 2.8074e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.67372e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.67372e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 42160, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.67372e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.67372e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.67372e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.8074e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.8074e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX ", "code_information": [ { "code": "1633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 54066.9,"maximum": 3.73882e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.56078e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.73882e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.56078e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.73882e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.56078e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.56078e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 54066.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.56078e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX ", "code_information": [ { "code": "1634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 87115.7,"maximum": 5.85872e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.57973e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.57973e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.85872e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.85872e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.57973e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 87115.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.57973e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.57973e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR CHEST PROCEDURES WITH CC", "code_information": [ { "code": "164", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12879.1,"maximum": 39676.6,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 23352.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 22240.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 22240.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 23129.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 28912.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 29252.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 32311.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 22240.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 33718.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 22907.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 22240.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 22240.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 22240.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 26688.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 22240.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 29584.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 39676.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 32311.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 22240.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 31247.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 34472.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 22240.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 23352.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 12879.1, "methodology": "case rate" }]}]} , { "description": "MAJOR CHEST PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "165", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16293.2,"maximum": 29191.2,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 16450.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 16450.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 22989.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 16450.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 17273.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 19741, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21386.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 17108.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 16450.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 29191.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 16944.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 23421.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 17273.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 16293.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 24807.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 16450.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 25498.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 16450.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 16450.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 16450.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 21766.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 23421.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 16450.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 21203.8, "methodology": "case rate" }]}]} , { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX ", "code_information": [ { "code": "1651", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 38420.3,"maximum": 2.55138e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.55138e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.42989e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.42989e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.42989e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.42989e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 38420.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.55138e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.42989e+008, "methodology": "case rate" }]}]} , { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX ", "code_information": [ { "code": "1652", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 41319.7,"maximum": 2.86306e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.86306e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.86306e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.72673e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.72673e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.72673e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.72673e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 41319.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.72673e+008, "methodology": "case rate" }]}]} , { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX ", "code_information": [ { "code": "1653", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 52532.2,"maximum": 3.66169e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.48732e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.48732e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.48732e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 52532.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.48732e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.66169e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.66169e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.48732e+008, "methodology": "case rate" }]}]} , { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX ", "code_information": [ { "code": "1654", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 78201.6,"maximum": 5.47148e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 78201.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.47148e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.47148e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.21093e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.21093e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.21093e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.21093e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.21093e+008, "methodology": "case rate" }]}]} , { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "166", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9634.12,"maximum": 63127.2,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 35187.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 36947.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 45744.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 39688.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 53648.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 35187.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 43839.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 35187.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 63127.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 43839.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 35187.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 42225.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 54541, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 9634.12, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 49716.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 47070.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 35187.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 36947.1, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 35187.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 36595.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 35187.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 35187.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 35187.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 36243.4, "methodology": "case rate" }]}]} , { "description": "CORONARY BYPASS W/O AMI OR COMPLEX PDX ", "code_information": [ { "code": "1661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 31764.7,"maximum": 2.11878e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.11878e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.01789e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.01789e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 31764.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.01789e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.01789e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.01789e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.11878e+008, "methodology": "case rate" }]}]} , { "description": "CORONARY BYPASS W/O AMI OR COMPLEX PDX ", "code_information": [ { "code": "1662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 35998,"maximum": 2.44481e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 35998, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.32839e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.32839e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.32839e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.44481e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.32839e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.44481e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.32839e+008, "methodology": "case rate" }]}]} , { "description": "CORONARY BYPASS W/O AMI OR COMPLEX PDX ", "code_information": [ { "code": "1663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 44964.2,"maximum": 3.07796e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.07796e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 44964.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.93139e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.93139e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.93139e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.07796e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.93139e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.93139e+008, "methodology": "case rate" }]}]} , { "description": "CORONARY BYPASS W/O AMI OR COMPLEX PDX ", "code_information": [ { "code": "1664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 68426.5,"maximum": 4.79147e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.79147e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.5633e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.79147e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.5633e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.5633e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 68426.5, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.5633e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.5633e+008, "methodology": "case rate" }]}]} , { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC", "code_information": [ { "code": "167", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10563.6,"maximum": 28310.6,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 15964.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 24059.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 21109.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 28310.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 16603.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15964.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 23982, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 15964.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 24745.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 20754.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 21711.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 23982, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 10563.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 16443.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 15964.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15964.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 16762.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 15964.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 15964.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 19157.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 15964.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 16762.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 15964.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 22296.2, "methodology": "case rate" }]}]} , { "description": "OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES ", "code_information": [ { "code": "1671", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 29836.6,"maximum": 2.11816e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.01729e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.01729e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.01729e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 29836.6, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.01729e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.11816e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.01729e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.11816e+008, "methodology": "case rate" }]}]} , { "description": "OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES ", "code_information": [ { "code": "1672", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 33257.1,"maximum": 2.19316e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.08872e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 33257.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.08872e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.08872e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.08872e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.19316e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.08872e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.19316e+008, "methodology": "case rate" }]}]} , { "description": "OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES ", "code_information": [ { "code": "1673", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 45318.9,"maximum": 3.38945e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.22805e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.38945e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.22805e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 45318.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.38945e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.22805e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.22805e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.22805e+008, "methodology": "case rate" }]}]} , { "description": "OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES ", "code_information": [ { "code": "1674", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 79431.8,"maximum": 5.89853e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.61765e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.61765e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.61765e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.61765e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.61765e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.89853e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 79431.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.89853e+008, "methodology": "case rate" }]}]} , { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "168", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11978.3,"maximum": 21090.6,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 11978.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 11978.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 12457.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 11978.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 15466, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 21090.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 12337.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 15571.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 11978.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 11978.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11978.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 14374, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 11978.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 12577.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 17923.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 17083.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 15726.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 14510.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 17083.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 11978.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 18566.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 16610, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 12577.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11978.3, "methodology": "case rate" }]}]} , { "description": "MAJOR ABDOMINAL VASCULAR PROCEDURES ", "code_information": [ { "code": "1691", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 17094.5,"maximum": 1.93034e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.83842e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.83842e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 17094.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.93034e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.93034e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.83842e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.83842e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.83842e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR ABDOMINAL VASCULAR PROCEDURES ", "code_information": [ { "code": "1692", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22589.2,"maximum": 1.96441e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.87086e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.87086e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.87086e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 22589.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.87086e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.96441e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.96441e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.87086e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR ABDOMINAL VASCULAR PROCEDURES ", "code_information": [ { "code": "1693", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 36602.3,"maximum": 2.6667e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.53971e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.53971e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.6667e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 36602.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.6667e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.53971e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.53971e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.53971e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR ABDOMINAL VASCULAR PROCEDURES ", "code_information": [ { "code": "1694", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 66523.2,"maximum": 4.22259e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 66523.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.02151e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.22259e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.02151e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.02151e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.02151e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.22259e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.02151e+008, "methodology": "case rate" }]}]} , { "description": "DESTRUCT PREMALG LESION", "code_information": [ { "code": "17000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 765.6, "discounted_cash": 256,"minimum": 18.16,"maximum": 765.6,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 612.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 765.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 765.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 765.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 612.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 765.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 421.08, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 229.68, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 765.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 765.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 765.6, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" }]}]} , { "description": "Destruct premalg les 2-14", "code_information": [ { "code": "17003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 970,"minimum": 4.25,"maximum": 970,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.25, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 291, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 776, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 970, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 970, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 970, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 776, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.25, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 970, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 533.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 970, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "DESTROY PREMAL LESIONS 15/>", "code_information": [ { "code": "17004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1463.1, "discounted_cash": 511,"minimum": 18.16,"maximum": 1463.1,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 590.52, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 610.2, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 405.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1463.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 116.39, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1170.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 409.43, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 116.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 803.11, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 128.03, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 116.39, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 804.71, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 934.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 413.36, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 433.05, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 551.15, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1170.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 472.42, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 787.36, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 393.68, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 438.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 314.94, "methodology": "fee schedule" }]}]} , { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK ", "code_information": [ { "code": "1701", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23393,"maximum": 1.42654e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.42654e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.35861e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.35861e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.42654e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.35861e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 23393, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.35861e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.35861e+008, "methodology": "case rate" }]}]} , { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK ", "code_information": [ { "code": "1702", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 24953.8,"maximum": 1.50522e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.43355e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.43355e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.43355e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.50522e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.50522e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.43355e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 24953.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.43355e+008, "methodology": "case rate" }]}]} , { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK ", "code_information": [ { "code": "1703", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 30645,"maximum": 2.17862e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.17862e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.07488e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.07488e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.07488e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.17862e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 30645, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.07488e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.07488e+008, "methodology": "case rate" }]}]} , { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK ", "code_information": [ { "code": "1704", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 48989.5,"maximum": 3.09693e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.94946e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 48989.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.94946e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.94946e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.09693e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.94946e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.09693e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.94946e+008, "methodology": "case rate" }]}]} , { "description": "PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK ", "code_information": [ { "code": "1711", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16163.1,"maximum": 1.08036e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.02891e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.02891e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.02891e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.08036e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16163.1, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.02891e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.02891e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.08036e+008, "methodology": "case rate" }]}]} , { "description": "Destruct b9 lesion 1-14", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7188, "discounted_cash": 256,"minimum": 18.16,"maximum": 5750.4,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 471.25, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2156.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 471.25, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 377, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 645, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5750.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 51.94, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 645, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3953.4, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 471.25, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 709.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 259.19, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 645, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 377, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 471.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 471.25, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 471.25, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5750.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 141.38, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 471.25, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" }]}]} , { "description": "DESTRUCT LESION 15 OR MORE", "code_information": [ { "code": "17111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.45, "discounted_cash": 256,"minimum": 18.16,"maximum": 513.45,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 54.45, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 154.04, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 513.45, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 513.45, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 410.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 51.37, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 513.45, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 513.45, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 513.45, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 410.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 513.45, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 282.4, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 513.45, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" }]}]} , { "description": "PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK ", "code_information": [ { "code": "1712", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 18469.6,"maximum": 1.24059e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.18152e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.24059e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.18152e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.18152e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.18152e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.18152e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.24059e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18469.6, "methodology": "case rate" }]}]} , { "description": "PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK ", "code_information": [ { "code": "1713", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23497.2,"maximum": 1.66546e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 23497.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.66546e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.66546e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.58615e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.58615e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.58615e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.58615e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.58615e+008, "methodology": "case rate" }]}]} , { "description": "PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK ", "code_information": [ { "code": "1714", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 39135.5,"maximum": 2.67031e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.54316e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.54316e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.54316e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.67031e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.54316e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.67031e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 39135.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.54316e+008, "methodology": "case rate" }]}]} , { "description": "Chem caut of granltj tissue", "code_information": [ { "code": "17250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.38, "discounted_cash": 256,"minimum": 18.16,"maximum": 183.38,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 100.86, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 146.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 146.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 55.01, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 25.82, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 28.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 25.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 25.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 183.38, "methodology": "case rate" }]}]} , { "description": "DSTRJ MAL LES T/A/L 1.1-2.0", "code_information": [ { "code": "17262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 623.45, "discounted_cash": 256,"minimum": 158.13,"maximum": 469.33,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" }]}]} , { "description": "Dstrj mal les t/a/l 2.1-3.0", "code_information": [ { "code": "17263", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 623.45, "discounted_cash": 256,"minimum": 158.13,"maximum": 469.33,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" }]}]} , { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM", "code_information": [ { "code": "173", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 26746.1,"maximum": 47837.8,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 27548.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 26746.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 35670, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 40654.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 27815.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 26746.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 47837.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 34769.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 26746.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 26746.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 28083.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 41456.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 26746.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 28083.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 26746.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 37674.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 26746.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 26746.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 32095.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 26746.1, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS CORONARY INTERVENTION W AMI ", "code_information": [ { "code": "1741", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 19333.5,"maximum": 1.27036e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.20986e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.20986e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.27036e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.27036e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.20986e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.20986e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 19333.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.20986e+008, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS CORONARY INTERVENTION W AMI ", "code_information": [ { "code": "1742", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20824,"maximum": 1.40782e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.34078e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.34078e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.40782e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20824, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.40782e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.34078e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.34078e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.34078e+008, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS CORONARY INTERVENTION W AMI ", "code_information": [ { "code": "1743", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 26319.5,"maximum": 1.81865e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.73204e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 26319.5, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.73204e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.81865e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.73204e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.81865e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.73204e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.73204e+008, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS CORONARY INTERVENTION W AMI ", "code_information": [ { "code": "1744", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 42855.3,"maximum": 2.71131e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.71131e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.5822e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.71131e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.5822e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.5822e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 42855.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.5822e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.5822e+008, "methodology": "case rate" }]}]} , { "description": "PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE", "code_information": [ { "code": "175", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6965.38,"maximum": 21826.5,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 12384.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 12384.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 12384.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 12880, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 19196.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 12384.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6965.38, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 17189.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 12756.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 14861.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 12384.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 12384.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 16851, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 13003.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 12384.6, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 16100, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 12384.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 18613.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 18549.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 13003.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 12384.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 16274.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 21826.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 18613.2, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS CORONARY INTERVENTION W/O AMI ", "code_information": [ { "code": "1751", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 19221.4,"maximum": 1.49037e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.4194e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 19221.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.49037e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.49037e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.4194e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.4194e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.4194e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.4194e+008, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS CORONARY INTERVENTION W/O AMI ", "code_information": [ { "code": "1752", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21186.6,"maximum": 1.64106e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.56292e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.64106e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.56292e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.64106e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.56292e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.56292e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.56292e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 21186.6, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS CORONARY INTERVENTION W/O AMI ", "code_information": [ { "code": "1753", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 26892.4,"maximum": 2.05957e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 26892.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.96149e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.96149e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.05957e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.96149e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.96149e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.05957e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.96149e+008, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS CORONARY INTERVENTION W/O AMI ", "code_information": [ { "code": "1754", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 50508.6,"maximum": 3.05269e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.90732e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.05269e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.90732e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.90732e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 50508.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.90732e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.90732e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.05269e+008, "methodology": "case rate" }]}]} , { "description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [ { "code": "176", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6360.27,"maximum": 12688.3,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7339.19, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 12688.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10783, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9460.96, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11375.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10494.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7706.15, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7339.19, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7339.19, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11591.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9992.73, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6360.27, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9540.95, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7339.19, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7339.19, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11591.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7339.19, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7339.19, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7339.19, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7632.76, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8807.03, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7339.19, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7706.15, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7559.37, "methodology": "case rate" }]}]} , { "description": "INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES", "code_information": [ { "code": "1761", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15183,"maximum": 1.16846e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.11282e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.16846e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15183, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.11282e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.11282e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.16846e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.11282e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.11282e+008, "methodology": "case rate" }]}]} , { "description": "INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES", "code_information": [ { "code": "1762", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 29029.5,"maximum": 1.45524e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.45524e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.45524e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 29029.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.38594e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.38594e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.38594e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.38594e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.38594e+008, "methodology": "case rate" }]}]} , { "description": "INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES", "code_information": [ { "code": "1763", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 30248.3,"maximum": 2.20096e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.20096e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.09615e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.20096e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.09615e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 30248.3, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.09615e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.09615e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.09615e+008, "methodology": "case rate" }]}]} , { "description": "INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES", "code_information": [ { "code": "1764", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 48030.2,"maximum": 3.78e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.6e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 48030.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.78e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.6e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.78e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.6e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.6e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.6e+008, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC", "code_information": [ { "code": "177", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6656.83,"maximum": 26390.9,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 14904.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 23277.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 14904.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 23102.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20784.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22428.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 15500.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 14904.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 21073.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6656.83, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 15650, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 14904.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 14904.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 14904.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 19678.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 17885.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 19376.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 14904.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 26390.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 15351.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 14904.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 15650, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 14904.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 23277.3, "methodology": "case rate" }]}]} , { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT ", "code_information": [ { "code": "1771", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12505.7,"maximum": 9.39337e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.94607e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.39337e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.39337e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.94607e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.94607e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.94607e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12505.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.94607e+007, "methodology": "case rate" }]}]} , { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT ", "code_information": [ { "code": "1772", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16188.1,"maximum": 1.2663e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.206e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.2663e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16188.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.206e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.206e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.206e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.206e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.2663e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT ", "code_information": [ { "code": "1773", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22955.8,"maximum": 1.87973e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 22955.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.87973e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.79022e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.79022e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.79022e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.87973e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.79022e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.79022e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT ", "code_information": [ { "code": "1774", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 46419.2,"maximum": 2.42422e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.30878e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.30878e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.42422e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.30878e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 46419.2, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.30878e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.42422e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.30878e+008, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC", "code_information": [ { "code": "178", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5872.22,"maximum": 16249.6,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10570.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 16249.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8808.83, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8808.83, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 15350.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8808.83, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8808.83, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9073.09, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 5872.22, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8808.83, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8808.83, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 12089, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8808.83, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8808.83, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 13653.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 14711.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 9249.27, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11445.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9249.27, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13045.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 16249.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8808.83, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11451.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9161.18, "methodology": "case rate" }]}]} , { "description": "EXTERNAL HEART ASSIST SYSTEMS", "code_information": [ { "code": "1781", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3.21212e+008,"maximum": 3.37273e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.21212e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.21212e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.37273e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.21212e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.21212e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.21212e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.37273e+008, "methodology": "case rate" }]}]} , { "description": "EXTERNAL HEART ASSIST SYSTEMS", "code_information": [ { "code": "1782", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3.78618e+008,"maximum": 3.97549e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.78618e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.97549e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.78618e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.78618e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.78618e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.78618e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.97549e+008, "methodology": "case rate" }]}]} , { "description": "EXTERNAL HEART ASSIST SYSTEMS", "code_information": [ { "code": "1783", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3.93861e+008,"maximum": 4.13554e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.13554e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.13554e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.93861e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.93861e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.93861e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.93861e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.93861e+008, "methodology": "case rate" }]}]} , { "description": "EXTERNAL HEART ASSIST SYSTEMS", "code_information": [ { "code": "1784", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5.34708e+008,"maximum": 5.61443e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.34708e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.34708e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.34708e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.34708e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.34708e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.61443e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.61443e+008, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC", "code_information": [ { "code": "179", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5657.21,"maximum": 11874.7,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8956.95, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7096.66, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10679.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6889.96, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7234.46, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6889.96, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10091.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 5657.21, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6889.96, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7165.56, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6889.96, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7234.46, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11874.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11870.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9351.95, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6889.96, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8854.28, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8267.95, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6889.96, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11870.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6889.96, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10747, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6889.96, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6889.96, "methodology": "case rate" }]}]} , { "description": "DEFIBRILLATOR IMPLANTS", "code_information": [ { "code": "1791", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 2.24638e+008,"maximum": 2.3587e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.3587e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.24638e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.24638e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.24638e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.24638e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.24638e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.3587e+008, "methodology": "case rate" }]}]} , { "description": "DEFIBRILLATOR IMPLANTS", "code_information": [ { "code": "1792", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 2.55629e+008,"maximum": 2.6841e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.6841e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.6841e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.55629e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.55629e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.55629e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.55629e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.55629e+008, "methodology": "case rate" }]}]} , { "description": "DEFIBRILLATOR IMPLANTS", "code_information": [ { "code": "1793", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3.13635e+008,"maximum": 3.29317e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.29317e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.13635e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.13635e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.13635e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.13635e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.13635e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.29317e+008, "methodology": "case rate" }]}]} , { "description": "DEFIBRILLATOR IMPLANTS", "code_information": [ { "code": "1794", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4.33344e+008,"maximum": 4.55011e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.33344e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.55011e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.55011e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.33344e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.33344e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.33344e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.33344e+008, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY NEOPLASMS WITH MCC", "code_information": [ { "code": "180", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7009.14,"maximum": 27041.2,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 18316.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 15874.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 23658.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 16027, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 20163.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15263.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 19842.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 21296.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 19447, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 27041.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 15263.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15263.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 15263.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 15263.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 15721.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 15263.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7009.14, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22980.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 15263.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 16027, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 21480.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 15263.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 15263.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 21480.7, "methodology": "case rate" }]}]} , { "description": "OTHER CIRCULATORY SYSTEM PROCEDURES ", "code_information": [ { "code": "1801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12094.8,"maximum": 8.78936e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.78936e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.37082e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.37082e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.37082e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.37082e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.78936e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.37082e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12094.8, "methodology": "case rate" }]}]} , { "description": "OTHER CIRCULATORY SYSTEM PROCEDURES ", "code_information": [ { "code": "1802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15282.6,"maximum": 1.11898e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.0657e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.0657e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.0657e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.11898e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.0657e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.11898e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15282.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.0657e+008, "methodology": "case rate" }]}]} , { "description": "OTHER CIRCULATORY SYSTEM PROCEDURES ", "code_information": [ { "code": "1803", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23420.3,"maximum": 1.56881e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.4941e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.56881e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.4941e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 23420.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.56881e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.4941e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.4941e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.4941e+008, "methodology": "case rate" }]}]} , { "description": "OTHER CIRCULATORY SYSTEM PROCEDURES ", "code_information": [ { "code": "1804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 41077,"maximum": 2.72454e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.72454e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.5948e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.5948e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.5948e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.5948e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.5948e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 41077, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.72454e+008, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY NEOPLASMS WITH CC", "code_information": [ { "code": "181", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6890.06,"maximum": 17129.8,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 12728.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 14557.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9791.46, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 17129.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11749.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 10281, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 13211.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9791.46, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9791.46, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 10085.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9791.46, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9791.46, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9791.46, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9791.46, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 10281, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9791.46, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 13490.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 14593.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 12772.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9791.46, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6890.06, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 10183.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 15176.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 14593.2, "methodology": "case rate" }]}]} , { "description": "LOWER EXTREMITY ARTERIAL PROCEDURES ", "code_information": [ { "code": "1811", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15024.1,"maximum": 1.02513e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.76318e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.02513e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.76318e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.76318e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.02513e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.76318e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15024.1, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.76318e+007, "methodology": "case rate" }]}]} , { "description": "LOWER EXTREMITY ARTERIAL PROCEDURES ", "code_information": [ { "code": "1812", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20352.4,"maximum": 1.48937e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.41845e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.41845e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.41845e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.48937e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.48937e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20352.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.41845e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.41845e+008, "methodology": "case rate" }]}]} , { "description": "LOWER EXTREMITY ARTERIAL PROCEDURES ", "code_information": [ { "code": "1813", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 33785.4,"maximum": 2.35071e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.35071e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.23877e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.23877e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 33785.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.23877e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.23877e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.35071e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.23877e+008, "methodology": "case rate" }]}]} , { "description": "LOWER EXTREMITY ARTERIAL PROCEDURES ", "code_information": [ { "code": "1814", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 60202.8,"maximum": 3.67579e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.50076e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.50076e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.67579e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.67579e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 60202.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.50076e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.50076e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.50076e+008, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY NEOPLASMS WITHOUT CC/MCC", "code_information": [ { "code": "182", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7194.89,"maximum": 11807.8,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7482.69, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7194.89, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9299.27, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8633.87, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11152.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7194.89, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 9327.19, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7194.89, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 10302.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7194.89, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7554.63, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7554.63, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 10302.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11807.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10034.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8804.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7194.89, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9353.36, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7194.89, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7845.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7194.89, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7194.89, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7194.89, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7410.74, "methodology": "case rate" }]}]} , { "description": "OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES", "code_information": [ { "code": "1821", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 19243.5,"maximum": 1.37456e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.30911e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.30911e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.30911e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.37456e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.30911e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 19243.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.37456e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.30911e+008, "methodology": "case rate" }]}]} , { "description": "OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES", "code_information": [ { "code": "1822", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22637,"maximum": 1.54216e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 22637, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.46873e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.46873e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.54216e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.46873e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.46873e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.54216e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.46873e+008, "methodology": "case rate" }]}]} , { "description": "OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES", "code_information": [ { "code": "1823", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 30723.3,"maximum": 1.88909e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 30723.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.88909e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.79914e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.88909e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.79914e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.79914e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.79914e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.79914e+008, "methodology": "case rate" }]}]} , { "description": "OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES", "code_information": [ { "code": "1824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 54930.4,"maximum": 3.35557e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.35557e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 54930.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.35557e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.19578e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.19578e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.19578e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.19578e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.19578e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR CHEST TRAUMA WITH MCC", "code_information": [ { "code": "183", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6794.14,"maximum": 24494.5,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13857.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 14273.4, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 18015, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13857.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 18935.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13857.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13857.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13857.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13857.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 18264.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 16629.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 17143.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 19290.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13857.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13857.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 18935.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14412, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 20816.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 21479.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13857.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 14550.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6794.14, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 24494.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14550.6, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES", "code_information": [ { "code": "1831", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 2.45021e+008,"maximum": 2.57272e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.45021e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.45021e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.45021e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.45021e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.57272e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.45021e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.57272e+008, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES", "code_information": [ { "code": "1832", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 2.56936e+008,"maximum": 2.69783e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.56936e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.56936e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.69783e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.56936e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.56936e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.69783e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.56936e+008, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES", "code_information": [ { "code": "1833", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3.12078e+008,"maximum": 3.27682e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.27682e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.27682e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.12078e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.12078e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.12078e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.12078e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.12078e+008, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES", "code_information": [ { "code": "1834", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4.65987e+008,"maximum": 4.89286e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.89286e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.65987e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.89286e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.65987e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.65987e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.65987e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.65987e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR CHEST TRAUMA WITH CC", "code_information": [ { "code": "184", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6775.68,"maximum": 16364.4,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6775.68, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9368.86, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9368.86, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9368.86, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 16364.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11242.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9368.86, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9368.86, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9368.86, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 12887.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9368.86, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13907.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 12899.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 12202, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9649.93, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 12899.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9837.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9368.86, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9743.61, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9368.86, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 14521.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 12179.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 9837.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 11678.3, "methodology": "case rate" }]}]} , { "description": "MAJOR CHEST TRAUMA WITHOUT CC/MCC", "code_information": [ { "code": "185", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6674.2,"maximum": 11756.4,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8766.12, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6824.68, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6824.68, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8189.62, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9523.38, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9523.38, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6824.68, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7165.91, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7029.42, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6824.68, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10578.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6824.68, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7165.91, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9991.11, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6824.68, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11756.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8621.76, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7097.67, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6824.68, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6824.68, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6824.68, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9258.84, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8872.08, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6674.2, "methodology": "case rate" }]}]} , { "description": "PLEURAL EFFUSION WITH MCC", "code_information": [ { "code": "186", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6905.4,"maximum": 24146,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 14075.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13665.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 18004.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 19787, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 24146, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13665.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13665.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 21181.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 17764.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13665.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 14348.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 20520.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13665.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 17913.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13665.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 16398.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 19016.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14211.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13665.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13665.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14348.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6905.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 19787, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13665.3, "methodology": "case rate" }]}]} , { "description": "PLEURAL EFFUSION WITH CC", "code_information": [ { "code": "187", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6561.5,"maximum": 15499.4,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 13514.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11558.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8891.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9246.95, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9335.86, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 15499.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8891.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8891.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10669.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8891.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11557.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6561.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8891.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8891.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 12235.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 12206.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13172.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 9335.86, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 13781.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 13514.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9158.04, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8891.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8891.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8891.3, "methodology": "case rate" }]}]} , { "description": "PLEURAL EFFUSION WITHOUT CC/MCC", "code_information": [ { "code": "188", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6121.89,"maximum": 11613.3,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7015.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6745.67, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9146.12, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8094.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10455.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6948.04, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6745.67, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7082.95, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9956.41, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9956.41, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11613.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7082.95, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6745.67, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6121.89, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 9013.79, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6745.67, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6745.67, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9869.48, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6745.67, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6745.67, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6745.67, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6745.67, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8659.4, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8769.37, "methodology": "case rate" }]}]} , { "description": "PULMONARY EDEMA AND RESPIRATORY FAILURE", "code_information": [ { "code": "189", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6706.78,"maximum": 19166.2,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 15764.4, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11461.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11461.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11243.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 13099, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 15094.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10915.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11352.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 14291.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16288.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10915.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10915.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10915.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 19166.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 16919.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10915.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10915.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10915.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 14190.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6706.78, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10915.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 15764.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 14272, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10915.8, "methodology": "case rate" }]}]} , { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6209.06,"maximum": 17143.8,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 15188.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 17143.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 10093.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 14569.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9799.18, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9799.18, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11759, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 15211.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 12783.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9799.18, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 13771, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9799.18, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9799.18, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 12738.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 10289.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 15211.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 10191.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 10289.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 13501.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9799.18, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9799.18, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9799.18, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6209.06, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9799.18, "methodology": "case rate" }]}]} , { "description": "PUNCTURE ASPIR CYST BREAST", "code_information": [ { "code": "19000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2750, "discounted_cash": 903,"minimum": 18.16,"maximum": 2750,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2200, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2750, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 36.5, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 825, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1512.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 36.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 36.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40.15, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2200, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" }]}]} , { "description": "Puncture aspir cyst brst ea", "code_information": [ { "code": "19001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1375,"minimum": 18.16,"maximum": 1375,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1375, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 20.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 756.25, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 412.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1100, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1375, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 20.39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 20.39, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 22.43, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1375, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1100, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "ACUTE MYOCARDIAL INFARCTION ", "code_information": [ { "code": "1901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8158.65,"maximum": 5.55902e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.29431e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.29431e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.55902e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.55902e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8158.65, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.29431e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.29431e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.29431e+007, "methodology": "case rate" }]}]} , { "description": "ACUTE MYOCARDIAL INFARCTION ", "code_information": [ { "code": "1902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8995.96,"maximum": 6.16553e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.87193e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.87193e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.87193e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.87193e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.87193e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.16553e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.16553e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8995.96, "methodology": "case rate" }]}]} , { "description": "MASTOTOMY EXPL DRG ABSC DP", "code_information": [ { "code": "19020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9373.31, "discounted_cash": 2080,"minimum": 18.16,"maximum": 7498.65,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 903.1, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7498.65, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 821, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 821, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5155.32, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2811.99, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 821, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7498.65, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "ACUTE MYOCARDIAL INFARCTION ", "code_information": [ { "code": "1903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12256.7,"maximum": 8.38876e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12256.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.9893e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.9893e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.38876e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.9893e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.38876e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.9893e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.9893e+007, "methodology": "case rate" }]}]} , { "description": "Njx px only mam ducto/glcto", "code_information": [ { "code": "19030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1038,"minimum": 18.16,"maximum": 1038,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 311.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 830.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1038, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 830.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1038, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 570.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1038, "methodology": "case rate" }]}]} , { "description": "ACUTE MYOCARDIAL INFARCTION ", "code_information": [ { "code": "1904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22700.7,"maximum": 1.4251e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.35724e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.4251e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.35724e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.35724e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.35724e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.35724e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 22700.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.4251e+008, "methodology": "case rate" }]}]} , { "description": "BX BREAST 1ST LESION STRTCTC", "code_information": [ { "code": "19081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11453, "discounted_cash": 2080,"minimum": 18.16,"maximum": 9162.4,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 157.2, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 148.3, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6299.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9162.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3435.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9162.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "Bx breast add lesion strtctc", "code_information": [ { "code": "19082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11453,"minimum": 18.16,"maximum": 9162.4,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 70.38, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 77.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 70.38, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 70.38, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 70.38, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6299.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9162.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3435.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9162.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 74.6, "methodology": "fee schedule" }]}]} , { "description": "BX BREAST 1ST LESION US IMAG", "code_information": [ { "code": "19083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1054.31, "discounted_cash": 2080,"minimum": 18.16,"maximum": 1054.31,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 579.87, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 843.45, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1054.31, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1054.31, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1054.31, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 843.45, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1054.31, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1054.31, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1054.31, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 316.29, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Bx breast add lesion us imag", "code_information": [ { "code": "19084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11936,"minimum": 18.16,"maximum": 9548.8,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 66.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 66.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9548.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 66.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6564.8, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9548.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3580.8, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 70.09, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 66.12, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 72.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" }]}]} , { "description": "BX BREAST 1ST LESION MR IMAG", "code_information": [ { "code": "19085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12853, "discounted_cash": 2080,"minimum": 18.16,"maximum": 10282.4,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3855.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 10282.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 7069.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 171.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 162.1, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10282.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "Bx breast add lesion mr imag", "code_information": [ { "code": "19086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12853,"minimum": 18.16,"maximum": 10282.4,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3855.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 78.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 71.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 71.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 71.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 71.66, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 75.96, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 10282.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 7069.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10282.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6224.8,"maximum": 13207.9,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 13207.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11776.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6224.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7854.85, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7626.07, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7626.07, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9913.89, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10661.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7626.07, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7626.07, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9848.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11820.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11224.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7626.07, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7626.07, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11776.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9151.28, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7626.07, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8007.37, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7626.07, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8007.37, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7931.11, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7626.07, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10402, "methodology": "case rate" }]}]} , { "description": "BX BREAST PERCUT W/O IMAGE", "code_information": [ { "code": "19100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 955.9, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 869, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 869, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 869, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "Biopsy of breast open", "code_information": [ { "code": "19101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843, "discounted_cash": 4892,"minimum": 18.16,"maximum": 6843,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3763.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 5645.1, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 4139.74, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3010.72, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 774, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2052.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3913.94, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 851.4, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3876.3, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5268.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 5833.27, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 774, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 774, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3951.57, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6843, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 4516.08, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6843, "methodology": "fee schedule" }]}]} , { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE", "code_information": [ { "code": "1911", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9038.82,"maximum": 6.72961e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.40915e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9038.82, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.72961e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.72961e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.40915e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.40915e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.40915e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.40915e+007, "methodology": "case rate" }]}]} , { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE", "code_information": [ { "code": "1912", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10394.9,"maximum": 7.66246e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.66246e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10394.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.29758e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.29758e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.66246e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.29758e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.29758e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.29758e+007, "methodology": "case rate" }]}]} , { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE", "code_information": [ { "code": "1913", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13764.6,"maximum": 1.05221e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.00211e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.05221e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.00211e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.05221e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.00211e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 13764.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.00211e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.00211e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE", "code_information": [ { "code": "1914", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 26947.2,"maximum": 1.90619e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.81542e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.90619e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.90619e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.81542e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.81542e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 26947.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.81542e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.81542e+008, "methodology": "case rate" }]}]} , { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5764.56,"maximum": 9984.48,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 9984.48, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 5846.35, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 5846.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 7863.33, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8529.65, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 5764.56, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 5846.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7015.62, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 5846.35, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 5846.35, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9061.84, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 5846.35, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 8485.24, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6021.74, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6138.67, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 5846.35, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 5846.35, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 7600.26, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 5846.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9421.63, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 7444.88, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6138.67, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9421.63, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6080.2, "methodology": "case rate" }]}]} , { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS ", "code_information": [ { "code": "1921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9338.19,"maximum": 7.12583e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.7865e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.7865e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.7865e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9338.19, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.7865e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.12583e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.12583e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.7865e+007, "methodology": "case rate" }]}]} , { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS ", "code_information": [ { "code": "1922", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11534.1,"maximum": 8.68702e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.27335e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.68702e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.27335e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.27335e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.27335e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.68702e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.27335e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11534.1, "methodology": "case rate" }]}]} , { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS ", "code_information": [ { "code": "1923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16980.3,"maximum": 1.27872e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.27872e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.27872e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.21783e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.21783e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16980.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.21783e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.21783e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.21783e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS ", "code_information": [ { "code": "1924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 32272.7,"maximum": 2.27939e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.17085e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.27939e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.17085e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.17085e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.27939e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.17085e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 32272.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.17085e+008, "methodology": "case rate" }]}]} , { "description": "Perq device breast 1st imag", "code_information": [ { "code": "19281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8732, "discounted_cash": 2080,"minimum": 18.16,"maximum": 6985.6,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6985.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 82.59, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2619.6, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6985.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 82.59, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 82.59, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 82.59, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 90.85, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 87.55, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4802.6, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "PERQ DEVICE BREAST EA IMAG", "code_information": [ { "code": "19282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4366,"minimum": 18.16,"maximum": 3492.8,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 39.33, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 39.33, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 41.69, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 43.26, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 39.33, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1309.8, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 39.33, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2401.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Perq dev breast 1st strtctc", "code_information": [ { "code": "19283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9890, "discounted_cash": 903,"minimum": 18.16,"maximum": 7912,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 83.38, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7912, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7912, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 83.38, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 83.38, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 88.38, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2967, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 83.38, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 91.72, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5439.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" }]}]} , { "description": "PERQ DEV BREAST ADD STRTCTC", "code_information": [ { "code": "19284", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4945,"minimum": 18.16,"maximum": 3956,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 41.97, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2719.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3956, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 39.59, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1483.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 39.59, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 3956, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 43.55, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 39.59, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 39.59, "methodology": "fee schedule" }]}]} , { "description": "Perq dev breast 1st us imag", "code_information": [ { "code": "19285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5428, "discounted_cash": 903,"minimum": 18.16,"maximum": 4342.4,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 70.71, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 74.95, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 77.78, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4342.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1628.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 70.71, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2985.4, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4342.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 70.71, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 70.71, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" }]}]} , { "description": "PERQ DEV BREAST ADD US IMAG", "code_information": [ { "code": "19286", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5428,"minimum": 18.16,"maximum": 4342.4,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2985.4, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 33.98, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 33.98, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 36.02, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1628.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4342.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4342.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 33.98, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 37.38, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 33.98, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" }]}]} , { "description": "Perq dev breast 1st mr guide", "code_information": [ { "code": "19287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6345, "discounted_cash": 903,"minimum": 18.16,"maximum": 5076,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 127.14, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 122.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3489.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1903.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 115.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 115.58, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 115.58, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5076, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 115.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5076, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" }]}]} , { "description": "PERQ DEV BREAST ADD MR GUIDE", "code_information": [ { "code": "19288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6345,"minimum": 18.16,"maximum": 5076,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 50.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5076, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 50.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 50.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 50.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3489.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1903.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5076, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 53.87, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 55.9, "methodology": "fee schedule" }]}]} , { "description": "SIMPLE PNEUMONIA AND PLEURISY WITH MCC", "code_information": [ { "code": "193", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6314.28,"maximum": 20637.9,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 16774.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 14074, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 12197.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 20637.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 12314.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 17539, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 15246.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 15388.6, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 12314.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11728.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 11728.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11728.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 11728.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 15186.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 11728.4, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 12080.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6314.28, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 16774.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 16253.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 18179, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 11728.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 11728.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 11728.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 11728.4, "methodology": "case rate" }]}]} , { "description": "Mast simple complete", "code_information": [ { "code": "19303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9776.33, "discounted_cash": 8369,"minimum": 18.16,"maximum": 9776.33,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 9776.33, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6695.94, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6631.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5150.72, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9776.33, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9776.33, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9013.76, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9657.6, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9776.33, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7726.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2932.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7821.07, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6760.32, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5376.98, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7082.24, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7821.07, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" }]}]} , { "description": "ACUTE & SUBACUTE ENDOCARDITIS ", "code_information": [ { "code": "1931", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9571.76,"maximum": 6.51683e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.20651e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.51683e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.20651e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9571.76, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.20651e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.20651e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.20651e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.51683e+007, "methodology": "case rate" }]}]} , { "description": "Breast reduction", "code_information": [ { "code": "19318", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15895.2, "discounted_cash": 8369,"minimum": 18.16,"maximum": 15287.4,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6695.94, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6631.55, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 15287.4, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5150.72, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 4060.59, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4768.55, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 8742.35, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7082.24, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9979.52, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 13134.3, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 12876.8, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12716.1, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3217.46, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6760.32, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9657.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7726.08, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6438.4, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 12716.1, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9013.76, "methodology": "fee schedule" }]}]} , { "description": "ACUTE & SUBACUTE ENDOCARDITIS ", "code_information": [ { "code": "1932", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12434.8,"maximum": 7.72797e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.35997e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.72797e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.35997e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.35997e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.72797e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.35997e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12434.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.35997e+007, "methodology": "case rate" }]}]} , { "description": "Breast augmentation w/implt", "code_information": [ { "code": "19325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10368, "discounted_cash": 12099,"minimum": 18.16,"maximum": 10368,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10368, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10368, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10368, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9307.11, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9586.32, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8294.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10368, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9307.11, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9679.39, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 9307.11, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 10368, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9307.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3217.46, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8294.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9307.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 10237.8, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9307.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5702.4, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3110.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 4060.59, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9307.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9307.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9307.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 7445.69, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9307.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10368, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10368, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9772.47, "methodology": "fee schedule" }]}]} , { "description": "ACUTE & SUBACUTE ENDOCARDITIS ", "code_information": [ { "code": "1933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 18581.2,"maximum": 1.08915e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.03729e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.08915e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.03729e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.08915e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.03729e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.03729e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18581.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.03729e+008, "methodology": "case rate" }]}]} , { "description": "ACUTE & SUBACUTE ENDOCARDITIS ", "code_information": [ { "code": "1934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 30609.4,"maximum": 1.70989e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.70989e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 30609.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.62846e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.62846e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.62846e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.62846e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.70989e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.62846e+008, "methodology": "case rate" }]}]} , { "description": "REVJ PERI-IMPLT CAPSULE BRST", "code_information": [ { "code": "19370", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8493, "discounted_cash": 4892,"minimum": 18.16,"maximum": 8493,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 4139.74, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2547.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6794.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 7526.8, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6794.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3913.94, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3876.3, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 8493, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 4516.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5268.76, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 5645.1, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3010.72, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3763.4, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 5833.27, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3951.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 7677.34, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4671.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "SIMPLE PNEUMONIA AND PLEURISY WITH CC", "code_information": [ { "code": "194", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5634.56,"maximum": 12791,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7395.86, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7395.86, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11606.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7395.86, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7765.65, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7395.86, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 12791, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10507.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9614.62, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7395.86, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7617.74, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7395.86, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7691.69, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7395.86, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7765.65, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11606.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8875.03, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9537.52, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7395.86, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 5634.56, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10870.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7395.86, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11463.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10073.6, "methodology": "case rate" }]}]} , { "description": "HEART FAILURE ", "code_information": [ { "code": "1941", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5183.23,"maximum": 3.57415e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5183.23, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.40395e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.40395e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.40395e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.57415e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.40395e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.40395e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.57415e+007, "methodology": "case rate" }]}]} , { "description": "HEART FAILURE ", "code_information": [ { "code": "1942", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6655.79,"maximum": 4.77468e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.54731e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.54731e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.77468e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.77468e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.54731e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.54731e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6655.79, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.54731e+007, "methodology": "case rate" }]}]} , { "description": "HEART FAILURE ", "code_information": [ { "code": "1943", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9926.74,"maximum": 7.08153e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.74431e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.74431e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.08153e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9926.74, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.74431e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.08153e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.74431e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.74431e+007, "methodology": "case rate" }]}]} , { "description": "HEART FAILURE ", "code_information": [ { "code": "1944", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 18748.1,"maximum": 1.32801e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.32801e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18748.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.32801e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.26477e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.26477e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.26477e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.26477e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.26477e+008, "methodology": "case rate" }]}]} , { "description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC", "code_information": [ { "code": "195", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5426.84,"maximum": 9732.46,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 5707.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 5935.49, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 5878.42, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 5707.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 8958.83, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 5707.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 5707.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 8271.06, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 5426.84, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 7664.85, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 7256.96, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 5707.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 8846.16, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 5992.56, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 5992.56, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 8958.83, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 5707.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 5707.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8110.66, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 5707.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 9732.46, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 6848.64, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 7419.36, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 5707.2, "methodology": "case rate" }]}]} , { "description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [ { "code": "196", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6758.96,"maximum": 29486.7,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 16614, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 16614, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 16614, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 20762.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 16614, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 16614, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 19936.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21598.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 16614, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 17444.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 16614, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6758.96, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 20762.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 17444.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 18796.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 16614, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 21986.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 25059.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 16614, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 17278.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 17112.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 25751.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 29486.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 23222.4, "methodology": "case rate" }]}]} , { "description": "CARDIAC ARREST & SHOCK ", "code_information": [ { "code": "1961", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5397.46,"maximum": 3.1461e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.99629e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.99629e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.99629e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.99629e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.1461e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.1461e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5397.46, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.99629e+007, "methodology": "case rate" }]}]} , { "description": "CARDIAC ARREST & SHOCK ", "code_information": [ { "code": "1962", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5724.38,"maximum": 4.04213e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.84965e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.04213e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.84965e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.84965e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.84965e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.84965e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5724.38, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.04213e+007, "methodology": "case rate" }]}]} , { "description": "CARDIAC ARREST & SHOCK ", "code_information": [ { "code": "1963", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10864.2,"maximum": 6.85627e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.85627e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.52979e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10864.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.52979e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.52979e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.52979e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.52979e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.85627e+007, "methodology": "case rate" }]}]} , { "description": "CARDIAC ARREST & SHOCK ", "code_information": [ { "code": "1964", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 27729.9,"maximum": 1.36608e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 27729.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.30102e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.30102e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.30102e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.36608e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.30102e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.30102e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.36608e+008, "methodology": "case rate" }]}]} , { "description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [ { "code": "197", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6376.35,"maximum": 15518.1,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8901.61, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6376.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 12221.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8901.61, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11571, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13188, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9257.67, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9168.66, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 13797.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8901.61, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8901.61, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11572.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8901.61, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8901.61, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 9346.69, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9346.69, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 15518.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8901.61, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 12866, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8901.61, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10681.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 11647.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 12866, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8901.61, "methodology": "case rate" }]}]} , { "description": "PERIPHERAL & OTHER VASCULAR DISORDERS ", "code_information": [ { "code": "1971", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5165.94,"maximum": 4.05024e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.05024e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.85737e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5165.94, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.85737e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.85737e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.85737e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.05024e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.85737e+007, "methodology": "case rate" }]}]} , { "description": "PERIPHERAL & OTHER VASCULAR DISORDERS ", "code_information": [ { "code": "1972", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6897.38,"maximum": 5.12099e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.12099e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.87713e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.12099e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.87713e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.87713e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.87713e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6897.38, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.87713e+007, "methodology": "case rate" }]}]} , { "description": "PERIPHERAL & OTHER VASCULAR DISORDERS ", "code_information": [ { "code": "1973", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10243.7,"maximum": 7.34235e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.99272e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.34235e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.99272e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.34235e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.99272e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10243.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.99272e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.99272e+007, "methodology": "case rate" }]}]} , { "description": "PERIPHERAL & OTHER VASCULAR DISORDERS ", "code_information": [ { "code": "1974", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22123.3,"maximum": 1.38904e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.38904e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.32289e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.38904e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 22123.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.32289e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.32289e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.32289e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.32289e+008, "methodology": "case rate" }]}]} , { "description": "INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC", "code_information": [ { "code": "198", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6284.36,"maximum": 12106.5,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8916.06, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9534.51, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9027.12, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9123.33, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8421.54, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7017.95, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7017.95, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7017.95, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9848.46, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9848.46, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7368.85, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7228.49, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 12106.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7017.95, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7017.95, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7368.85, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7017.95, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7017.95, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7017.95, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7017.95, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6284.36, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10288.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7298.67, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10877.8, "methodology": "case rate" }]}]} , { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS ", "code_information": [ { "code": "1981", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4771.37,"maximum": 3.85182e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.6684e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.85182e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.6684e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4771.37, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.6684e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.6684e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.85182e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.6684e+007, "methodology": "case rate" }]}]} , { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS ", "code_information": [ { "code": "1982", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5511.56,"maximum": 4.42213e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.21155e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.21155e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.42213e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.21155e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.21155e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5511.56, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.42213e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.21155e+007, "methodology": "case rate" }]}]} , { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS ", "code_information": [ { "code": "1983", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7518.98,"maximum": 5.89285e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.61224e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.61224e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7518.98, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.89285e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.61224e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.89285e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.61224e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.61224e+007, "methodology": "case rate" }]}]} , { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS ", "code_information": [ { "code": "1984", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 18070.9,"maximum": 1.18188e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18070.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.18188e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.1256e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.18188e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.1256e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.1256e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.1256e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.1256e+008, "methodology": "case rate" }]}]} , { "description": "PNEUMOTHORAX WITH MCC", "code_information": [ { "code": "199", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6706.13,"maximum": 27599.7,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 20422, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 21736.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 22557.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 15572.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 16350.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 15572.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 24136.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 15572.1, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15572.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 20243.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 16039.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 22557.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 16350.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15572.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 15572.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 15572.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 16195, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 18686.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 15572.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 15572.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6706.13, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 20579.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 23455.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 27599.7, "methodology": "case rate" }]}]} , { "description": "HYPERTENSION ", "code_information": [ { "code": "1991", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4909.23,"maximum": 3.90424e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.90424e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.71832e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4909.23, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.90424e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.71832e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.71832e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.71832e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.71832e+007, "methodology": "case rate" }]}]} , { "description": "HYPERTENSION ", "code_information": [ { "code": "1992", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5764.99,"maximum": 4.58998e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5764.99, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.37141e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.58998e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.37141e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.58998e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.37141e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.37141e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.37141e+007, "methodology": "case rate" }]}]} , { "description": "HYPERTENSION ", "code_information": [ { "code": "1993", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8081.91,"maximum": 6.49499e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.49499e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.1857e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.1857e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.1857e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.1857e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.1857e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.49499e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8081.91, "methodology": "case rate" }]}]} , { "description": "HYPERTENSION ", "code_information": [ { "code": "1994", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 18424.5,"maximum": 1.18306e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.18306e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.12673e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.18306e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.12673e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.12673e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.12673e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.12673e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18424.5, "methodology": "case rate" }]}]} , { "description": "PNEUMOTHORAX WITH CC", "code_information": [ { "code": "200", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6725.24,"maximum": 16754.9,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 12493.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 14239, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9584.45, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9967.83, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 13773, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11501.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 14855.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 13195.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 13773, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9584.45, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9584.45, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 12459.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 10063.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 16754.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 10063.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 12469, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9584.45, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9584.45, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6725.24, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9584.45, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9584.45, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9584.45, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9871.98, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9584.45, "methodology": "case rate" }]}]} , { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS ", "code_information": [ { "code": "2001", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5891.65,"maximum": 4.34289e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.34289e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.13608e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.13608e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.13608e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.13608e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.34289e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.13608e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5891.65, "methodology": "case rate" }]}]} , { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS ", "code_information": [ { "code": "2002", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6970.41,"maximum": 5.65262e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.65262e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.38345e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.65262e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.38345e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.38345e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.38345e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.38345e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6970.41, "methodology": "case rate" }]}]} , { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS ", "code_information": [ { "code": "2003", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10625.4,"maximum": 8.21654e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10625.4, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.82528e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.21654e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.82528e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.82528e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.82528e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.82528e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.21654e+007, "methodology": "case rate" }]}]} , { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS ", "code_information": [ { "code": "2004", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22636.2,"maximum": 1.47739e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.47739e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.40704e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.47739e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.40704e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 22636.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.40704e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.40704e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.40704e+008, "methodology": "case rate" }]}]} , { "description": "PNEUMOTHORAX WITHOUT CC/MCC", "code_information": [ { "code": "201", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6154.87,"maximum": 10984.8,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6154.87, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6718.57, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6398.64, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9108.96, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8246.57, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6590.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6398.64, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6398.64, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9917.89, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 8651.14, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6398.64, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9108.96, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8318.23, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9335.35, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6398.64, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6398.64, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7678.37, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6718.57, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6654.59, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6398.64, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6398.64, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6398.64, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8190.76, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 10984.8, "methodology": "case rate" }]}]} , { "description": "Explore wound neck", "code_information": [ { "code": "20100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3437.5, "discounted_cash": 706,"minimum": 18.16,"maximum": 3425,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 434.58, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 760.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 841.99, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1031.25, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1890.63, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1108.17, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1086.44, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 651.86, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 559.52, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 564.95, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 814.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 570.38, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2750, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 597.54, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1289.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2750, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "EXPLORE WOUND CHEST", "code_information": [ { "code": "20101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10730.2, "discounted_cash": 2340,"minimum": 18.16,"maximum": 8584.15,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1440.39, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3600.98, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2790.76, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3219.06, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8584.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3673, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2700.74, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1872.51, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2520.69, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8584.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 2160.59, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4275.11, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1854.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5901.6, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1980.54, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1890.51, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" }]}]} , { "description": "Explore wound abdomen", "code_information": [ { "code": "20102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10730.2, "discounted_cash": 2340,"minimum": 18.16,"maximum": 8584.15,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 2160.59, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2700.74, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2520.69, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5901.6, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1890.51, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3600.98, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1440.39, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2790.76, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1980.54, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1872.51, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3219.06, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8584.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1854.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1800.49, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4275.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3673, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8584.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" }]}]} , { "description": "EXPLORE WOUND EXTREMITY", "code_information": [ { "code": "20103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6595, "discounted_cash": 2080,"minimum": 18.16,"maximum": 5276,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5276, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3627.25, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1978.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5276, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" }]}]} , { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS ", "code_information": [ { "code": "2011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4403.13,"maximum": 3.19539e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.04323e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.04323e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.04323e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.19539e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.19539e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.04323e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.04323e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4403.13, "methodology": "case rate" }]}]} , { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS ", "code_information": [ { "code": "2012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5703.62,"maximum": 4.11202e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.91621e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.11202e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.91621e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.11202e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.91621e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.91621e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.91621e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5703.62, "methodology": "case rate" }]}]} , { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS ", "code_information": [ { "code": "2013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8760.14,"maximum": 6.35647e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.05378e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.05378e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.05378e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8760.14, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.05378e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.05378e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.35647e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.35647e+007, "methodology": "case rate" }]}]} , { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS ", "code_information": [ { "code": "2014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 18176.2,"maximum": 1.23198e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.17332e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.17332e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18176.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.23198e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.17332e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.17332e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.17332e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.23198e+008, "methodology": "case rate" }]}]} , { "description": "BRONCHITIS AND ASTHMA WITH CC/MCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6430.34,"maximum": 14895.8,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11107, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8558.03, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8558.03, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8558.03, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8814.77, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8985.93, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14895.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 12101.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8558.03, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10269.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10956, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8558.03, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8900.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11731.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8985.93, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8558.03, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11125.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12659.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 13265, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8558.03, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 12101.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8558.03, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6430.34, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8558.03, "methodology": "case rate" }]}]} , { "description": "Muscle biopsy superficial", "code_information": [ { "code": "20200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" }]}]} , { "description": "DEEP MUSCLE BIOPSY", "code_information": [ { "code": "20205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 691, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 691, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 760.1, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 691, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" }]}]} , { "description": "Biopsy muscle perq needle", "code_information": [ { "code": "20206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5384, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4307.2,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2961.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4307.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1615.2, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4307.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Bone biopsy trocar/ndl supfc", "code_information": [ { "code": "20220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4147, "discounted_cash": 2080,"minimum": 18.16,"maximum": 3800.79,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3317.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 3317.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1244.1, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2280.85, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" }]}]} , { "description": "BONE BIOPSY TROCAR/NDL DEEP", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5395, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4316,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1618.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2967.25, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4316, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4316, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "Bone biopsy open superficial", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 842, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 842, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 842, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 926.2, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" }]}]} , { "description": "BONE BIOPSY OPEN DEEP", "code_information": [ { "code": "20245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" }]}]} , { "description": "BRONCHITIS AND ASTHMA WITHOUT CC/MCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6177.98,"maximum": 10810.6,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6302.45, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8060.84, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6491.52, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6302.45, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7562.94, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6302.45, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6302.45, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6302.45, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6177.98, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6617.57, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8193.18, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6302.45, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9085.39, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6554.55, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6302.45, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6302.45, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 8513.91, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9768.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 10810.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6617.57, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9085.39, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8225.23, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6302.45, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9187.27, "methodology": "case rate" }]}]} , { "description": "CHEST PAIN ", "code_information": [ { "code": "2031", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4924.23,"maximum": 4.09392e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.09392e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.89897e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.89897e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.89897e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.89897e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.09392e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.89897e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4924.23, "methodology": "case rate" }]}]} , { "description": "CHEST PAIN ", "code_information": [ { "code": "2032", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5726.87,"maximum": 4.56503e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.56503e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.56503e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.34764e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.34764e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.34764e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.34764e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5726.87, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.34764e+007, "methodology": "case rate" }]}]} , { "description": "CHEST PAIN ", "code_information": [ { "code": "2033", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7148.82,"maximum": 5.68132e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.41078e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.68132e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7148.82, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.41078e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.41078e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.41078e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.68132e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.41078e+007, "methodology": "case rate" }]}]} , { "description": "CHEST PAIN ", "code_information": [ { "code": "2034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12980.4,"maximum": 9.79458e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.32817e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.79458e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12980.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.79458e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.32817e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.32817e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.32817e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.32817e+007, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [ { "code": "204", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7401.89,"maximum": 12801.9,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7401.89, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11472.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7401.89, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7401.89, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7401.89, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7401.89, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7495.81, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7623.95, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7401.89, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7771.98, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 9018.28, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10879.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7697.97, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8882.27, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7771.98, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 12801.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9961.37, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9622.46, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7401.89, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7401.89, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7401.89, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10082.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9545.64, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9961.37, "methodology": "case rate" }]}]} , { "description": "SYNCOPE & COLLAPSE ", "code_information": [ { "code": "2041", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5474.91,"maximum": 4.54506e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.32863e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.32863e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.54506e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.32863e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5474.91, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.32863e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.54506e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.32863e+007, "methodology": "case rate" }]}]} , { "description": "SYNCOPE & COLLAPSE ", "code_information": [ { "code": "2042", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6182.11,"maximum": 5.00742e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.00742e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.00742e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.76897e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.76897e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.76897e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6182.11, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.76897e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.76897e+007, "methodology": "case rate" }]}]} , { "description": "SYNCOPE & COLLAPSE ", "code_information": [ { "code": "2043", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7799.96,"maximum": 6.31216e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7799.96, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.01158e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.01158e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.01158e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.31216e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.31216e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.01158e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.01158e+007, "methodology": "case rate" }]}]} , { "description": "SYNCOPE & COLLAPSE ", "code_information": [ { "code": "2044", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15990.5,"maximum": 1.1445e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.09e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15990.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.09e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.09e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.09e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.09e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.1445e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.1445e+008, "methodology": "case rate" }]}]} , { "description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "205", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7872.02,"maximum": 28162.8,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 17446.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 15883.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 20648, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 24618.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7872.02, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 16518.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 19059.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 16677.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 15883.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 15883.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 19270.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 28162.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 15883.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 15883.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 22179.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 15883.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 16677.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15883.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15883.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 23934, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 19270.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 20999.5, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 16359.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 15883.1, "methodology": "case rate" }]}]} , { "description": "INJECT SINUS TRACT FOR XRAY", "code_information": [ { "code": "20501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069,"minimum": 18.16,"maximum": 1069,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 35, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1069, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 855.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 38.5, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 320.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 855.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 587.95, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1069, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1069, "methodology": "case rate" }]}]} , { "description": "CARDIOMYOPATHY ", "code_information": [ { "code": "2051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5308.99,"maximum": 4.25678e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.05407e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.05407e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.25678e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.05407e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.05407e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.25678e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5308.99, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.05407e+007, "methodology": "case rate" }]}]} , { "description": "CARDIOMYOPATHY ", "code_information": [ { "code": "2052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6758.87,"maximum": 4.50013e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.28584e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.50013e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.50013e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.28584e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6758.87, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.28584e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.28584e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.28584e+007, "methodology": "case rate" }]}]} , { "description": "Removal of foreign body", "code_information": [ { "code": "20520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2390.25, "discounted_cash": 2080,"minimum": 18.16,"maximum": 2390.25,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2390.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 748, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1912.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 717.08, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2390.25, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2390.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2390.25, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1912.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 822.8, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 2390.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 748, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2390.25, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 748, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1314.64, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "REMOVE MUSCLE FOREIGN BODY", "code_information": [ { "code": "20525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4034, "discounted_cash": 3647,"minimum": 18.16,"maximum": 4034,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 4034, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4034, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 804, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4034, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4034, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4034, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3227.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1210.2, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 804, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 884.4, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 3227.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 804, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2218.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Ther injection carp tunnel", "code_information": [ { "code": "20526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1155, "discounted_cash": 380,"minimum": 18.16,"maximum": 1155,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 350.9, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 438.63, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 924, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1155, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 49.78, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 304.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 233.94, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 49.78, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1155, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 54.76, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 301.19, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 694.33, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 584.84, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 635.25, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 321.66, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 924, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 596.54, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 49.78, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 409.39, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1155, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 453.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 346.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 307.04, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" }]}]} , { "description": "CARDIOMYOPATHY ", "code_information": [ { "code": "2053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9757.1,"maximum": 7.48025e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.48025e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.12405e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.12405e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.12405e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.12405e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.48025e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9757.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.12405e+007, "methodology": "case rate" }]}]} , { "description": "CARDIOMYOPATHY ", "code_information": [ { "code": "2054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23941.5,"maximum": 1.61642e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.53944e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.53944e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.53944e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.61642e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.61642e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 23941.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.53944e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.53944e+008, "methodology": "case rate" }]}]} , { "description": "Inj tendon sheath/ligament", "code_information": [ { "code": "20550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1297.56, "discounted_cash": 380,"minimum": 18.16,"maximum": 1297.56,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 694.33, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1297.56, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 438.63, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 596.54, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 453.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 301.19, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 321.66, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1297.56, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 32, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 32, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 389.27, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 307.04, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 304.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 350.9, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1297.56, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 233.94, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 35.2, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1038.05, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1038.05, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 713.66, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 409.39, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 584.84, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 32, "methodology": "fee schedule" }]}]} , { "description": "INJ TENDON ORIGIN/INSERTION", "code_information": [ { "code": "20551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1155, "discounted_cash": 380,"minimum": 18.16,"maximum": 1155,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 924, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 584.84, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1155, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 438.63, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 596.54, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 233.94, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 301.19, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 635.25, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 350.9, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1155, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 453.25, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 38.76, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 42.64, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 38.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 346.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 38.76, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 307.04, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1155, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 694.33, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 409.39, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 924, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 304.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 321.66, "methodology": "fee schedule" }]}]} , { "description": "Inj trigger point 1/2 muscl", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1108.8, "discounted_cash": 380,"minimum": 18.16,"maximum": 1108.8,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1108.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 584.84, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 694.33, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 321.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 887.04, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 332.64, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 409.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 609.84, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1108.8, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 31.06, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 307.04, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 596.54, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 304.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 438.63, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 453.25, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 301.19, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1108.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 34.17, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 233.94, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 350.9, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 887.04, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 31.06, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 31.06, "methodology": "fee schedule" }]}]} , { "description": "INJECT TRIGGER POINTS 3/>", "code_information": [ { "code": "20553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1155, "discounted_cash": 380,"minimum": 18.16,"maximum": 1155,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 438.63, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 584.84, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 924, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1155, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 596.54, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 34.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 694.33, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1155, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 924, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 37.92, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 304.12, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 301.19, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 321.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 34.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 409.39, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 453.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 350.9, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 233.94, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 346.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1155, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 34.47, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 307.04, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 635.25, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC", "code_information": [ { "code": "206", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7239.52,"maximum": 14211.3,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8425.49, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11151.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14211.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11192.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8180.09, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8180.09, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8180.09, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10634.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8180.09, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10095.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8507.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9816.11, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 12679.1, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8180.09, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7239.52, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12077.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8180.09, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10596.6, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8589.09, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8180.09, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8180.09, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8589.09, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8180.09, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11151.3, "methodology": "case rate" }]}]} , { "description": "DRAIN/INJECT JOINT/BURSA", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1297.56, "discounted_cash": 380,"minimum": 18.16,"maximum": 1297.56,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1297.56, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 438.63, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1297.56, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 694.33, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1297.56, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1038.05, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 304.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1038.05, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 350.9, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 713.66, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 233.94, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 389.27, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 321.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 301.19, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 453.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 596.54, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 584.84, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 307.04, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 409.39, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "DRAIN/INJECT JOINT/BURSA", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1297.56, "discounted_cash": 380,"minimum": 18.16,"maximum": 1297.56,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1297.56, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 438.63, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1094, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 304.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1094, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 713.66, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1094, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 350.9, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 233.94, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1297.56, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 694.33, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 596.54, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1203.4, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 409.39, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1297.56, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 321.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 301.19, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1038.05, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1038.05, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 389.27, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 584.84, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 307.04, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 453.25, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" }]}]} , { "description": "Drain/inj joint/bursa w/us", "code_information": [ { "code": "20606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2535.95, "discounted_cash": 887,"minimum": 18.16,"maximum": 2028.76,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1621.18, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 682.77, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 703.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 682.77, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 682.77, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 682.77, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 44.89, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 682.77, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 710.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 42.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1024.15, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2028.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 716.91, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 682.77, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1392.85, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2028.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 682.77, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1058.29, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1365.54, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 682.77, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 819.32, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 751.05, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 546.22, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 682.77, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1394.77, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 955.88, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 682.77, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 760.78, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE ", "code_information": [ { "code": "2061", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6055.07,"maximum": 5.36996e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.11424e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.36996e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.36996e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.11424e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.11424e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6055.07, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.11424e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.11424e+007, "methodology": "case rate" }]}]} , { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1297.56, "discounted_cash": 380,"minimum": 18.16,"maximum": 1297.56,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 409.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 233.94, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1038.05, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 321.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1297.56, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 713.66, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 596.54, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 350.9, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1038.05, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 438.63, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 389.27, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 307.04, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 301.19, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 694.33, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1297.56, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1297.56, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 453.25, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 304.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 584.84, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" }]}]} , { "description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6322.44, "discounted_cash": 380,"minimum": 18.16,"maximum": 5057.95,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 596.54, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1896.73, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 438.63, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5057.95, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 304.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 350.9, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 321.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 453.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 301.19, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3477.34, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 694.33, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 307.04, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5057.95, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 233.94, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 409.39, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 584.84, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" }]}]} , { "description": "Aspirate/inj ganglion cyst", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1108.8, "discounted_cash": 380,"minimum": 18.16,"maximum": 1108.8,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 321.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 453.25, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 609.84, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 301.19, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1108.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 596.54, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 584.84, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 304.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 438.63, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 233.94, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1108.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1108.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 307.04, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 887.04, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 887.04, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 292.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 350.9, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 332.64, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 409.39, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 694.33, "methodology": "fee schedule" }]}]} , { "description": "TREATMENT OF BONE CYST", "code_information": [ { "code": "20615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 903,"minimum": 18.16,"maximum": 2695.55,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 808.66, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2695.55, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2156.44, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1482.55, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE ", "code_information": [ { "code": "2062", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7121.53,"maximum": 5.65324e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.65324e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.38404e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.65324e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.38404e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.38404e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.38404e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7121.53, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.38404e+007, "methodology": "case rate" }]}]} , { "description": "MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE ", "code_information": [ { "code": "2063", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11883.6,"maximum": 8.19658e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.80627e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.80627e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11883.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.19658e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.19658e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.80627e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.80627e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.80627e+007, "methodology": "case rate" }]}]} , { "description": "MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE ", "code_information": [ { "code": "2064", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22232.2,"maximum": 1.57317e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.57317e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 22232.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.49826e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.57317e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.49826e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.49826e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.49826e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.49826e+008, "methodology": "case rate" }]}]} , { "description": "APPLY REM FIXATION DEVICE", "code_information": [ { "code": "20660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" }]}]} , { "description": "REMOVAL IMPLANT SUPERFICIAL", "code_information": [ { "code": "20670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6993, "discounted_cash": 2080,"minimum": 18.16,"maximum": 5594.4,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 657, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 657, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3846.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 657, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2097.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 657, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 722.7, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 657, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 657, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 722.7, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "Removal of implant deep", "code_information": [ { "code": "20680", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7368, "discounted_cash": 3647,"minimum": 18.16,"maximum": 6661.32,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5894.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5894.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 720, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4052.4, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 792, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2210.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 720, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 720, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" }]}]} , { "description": "Appl mltpln uni ext fixj sys", "code_information": [ { "code": "20692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7743, "discounted_cash": 16892,"minimum": 18.16,"maximum": 7743,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4258.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2322.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 7743, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7743, "methodology": "fee schedule" }]}]} , { "description": "Rmvl ext fixj sys under anes", "code_information": [ { "code": "20694", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7743, "discounted_cash": 2062,"minimum": 18.16,"maximum": 6194.4,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4258.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2322.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" }]}]} , { "description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [ { "code": "207", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9253.16,"maximum": 107468,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 59669.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 84636.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 59669.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 59669.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 59669.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 59669.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 63261.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 59669.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 59669.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 9253.16, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 71603.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 92487.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 77570, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 80132.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 59669.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 62652.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 69876.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 69876.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 59669.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 107468, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 62056, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 61459.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 91330.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 62652.7, "methodology": "case rate" }]}]} , { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES ", "code_information": [ { "code": "2071", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5267.41,"maximum": 3.96726e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.77834e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.77834e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.77834e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.77834e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5267.41, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.96726e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.77834e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.96726e+007, "methodology": "case rate" }]}]} , { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES ", "code_information": [ { "code": "2072", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6987.83,"maximum": 5.08854e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.84623e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.84623e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.84623e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.08854e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.08854e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.84623e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.84623e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6987.83, "methodology": "case rate" }]}]} , { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES ", "code_information": [ { "code": "2073", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10148.5,"maximum": 7.4216e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10148.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.4216e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.06819e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.06819e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.06819e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.4216e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.06819e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.06819e+007, "methodology": "case rate" }]}]} , { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES ", "code_information": [ { "code": "2074", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 19790.9,"maximum": 1.38043e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.38043e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.31469e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.38043e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.31469e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.31469e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.31469e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.31469e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 19790.9, "methodology": "case rate" }]}]} , { "description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS", "code_information": [ { "code": "208", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10113.4,"maximum": 42063,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 36514.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 23557.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 30625, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 33127, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 23557.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 30679.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 30679.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 24500, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 24735.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 23557.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 23557.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 28269.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 35746.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 23557.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 24735.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 27775.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 42063, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 23557.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 31364.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 23557.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 10113.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 23557.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 23557.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 24264.4, "methodology": "case rate" }]}]} , { "description": "REPLANTATION DIGIT COMPLETE", "code_information": [ { "code": "20822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14681.3, "discounted_cash": 2062,"minimum": 1269.46,"maximum": 3767.76,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" }]}]} , { "description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [ { "code": "20982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26107.8, "discounted_cash": 16892,"minimum": 18.16,"maximum": 26107.8,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 19491.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 26107.8, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 13384.1, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 13514, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 13644, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 14359.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7832.35, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14293.7, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 20886.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 10395.4, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 18192, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 15593.1, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 26107.8, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 25988.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20886.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 20141.1, "methodology": "fee schedule" }]}]} , { "description": "Ablate bone tumor(s) perq", "code_information": [ { "code": "20983", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26107.8, "discounted_cash": 9182,"minimum": 18.16,"maximum": 20886.3,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 14359.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 14359.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16771.3, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10948.2, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14409.2, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20886.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14126.7, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 20886.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7832.35, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 14359.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10595, "methodology": "fee schedule" }]}]} , { "description": "EXC FACE LES SBQ 2 CM/<", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843, "discounted_cash": 2080,"minimum": 18.16,"maximum": 5474.4,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3763.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2052.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" }]}]} , { "description": "EXC FACE TUM DEEP 2 CM/>", "code_information": [ { "code": "21014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7533, "discounted_cash": 3647,"minimum": 18.16,"maximum": 6661.32,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2259.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4143.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 92847.5,"maximum": 167560,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 95632.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 92847.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 96561.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 143914, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 92847.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 92847.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 97489.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 92847.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 92847.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 120702, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 124940, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 131963, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 92847.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 142399, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 111417, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 92847.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 97489.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 92847.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 167560, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 92847.5, "methodology": "case rate" }]}]} , { "description": "GRAFT; EAR CARTILAGE, AUTOGRAFT", "code_information": [ { "code": "21235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25430.3, "discounted_cash": 7516,"minimum": 18.16,"maximum": 20344.2,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11795.1, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 5129.16, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6013.19, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 20344.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6071.01, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20344.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6360.1, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7629.07, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 6938.29, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 8961.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11563.8, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 13986.6, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13728.6, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 4625.53, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8672.86, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8094.67, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 5955.37, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 4064.16, "methodology": "case rate" }]}]} , { "description": "CLOSED TX NOSE FX W/O STABLJ", "code_information": [ { "code": "21315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2492.5, "discounted_cash": 1957,"minimum": 18.16,"maximum": 2492.5,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2492.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1806.84, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1994, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2333.84, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 645.7, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 587, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1370.88, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2492.5, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1565.93, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2107.98, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 587, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1204.56, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1550.87, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1994, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 126.67, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 747.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 587, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1656.27, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 2492.5, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1580.98, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2258.55, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 119.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" }]}]} , { "description": "Clsd tx nsl fx w/mnpj&stablj", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7233, "discounted_cash": 4132,"minimum": 18.16,"maximum": 8694.76,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 573, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4927.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8694.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2543.03, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 573, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 128.01, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3814.55, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 573, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 573, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2169.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7547.76, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4450.31, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8694.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4450.31, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6484.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6357.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5977.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3496.67, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3274.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 630.3, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3274.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6357.58, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3260.53, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 120.76, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3305.94, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2543.03, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3814.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4768.19, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4768.19, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3305.94, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3337.73, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7233, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3496.67, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3337.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 573, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5786.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4927.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6484.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 630.3, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3978.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5786.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 573, "methodology": "fee schedule" }]}]} , { "description": "CLOSED TX SEPTAL&NOSE FX", "code_information": [ { "code": "21337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10868.5, "discounted_cash": 4132,"minimum": 18.16,"maximum": 8694.76,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3274.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5977.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6484.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4768.19, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2543.03, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3496.67, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4450.31, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3305.94, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3337.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 43, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3814.55, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4927.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8694.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 45.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8694.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7547.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6357.58, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3260.53, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" }]}]} , { "description": "CLOSED TX NOSE/JAW FX", "code_information": [ { "code": "21345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5192.75, "discounted_cash": 1957,"minimum": 18.16,"maximum": 4154.2,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2856.01, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1565.93, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 4060.59, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1580.98, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4154.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2107.98, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 481.77, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 454.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3217.46, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2258.55, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4154.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3011.4, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1204.56, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1806.84, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1550.87, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1557.83, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3575.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2333.84, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1656.27, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3071.63, "methodology": "fee schedule" }]}]} , { "description": "CLOSED TX ORBIT W/O MANIPULJ", "code_information": [ { "code": "21400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3542.69, "discounted_cash": 706,"minimum": 18.16,"maximum": 2834.15,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 126, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2834.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1062.81, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 760.51, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 564.95, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 570.38, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 597.54, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1289.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1108.17, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 434.58, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2834.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 118.87, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1948.48, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 651.86, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 841.99, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 814.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1086.44, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 559.52, "methodology": "fee schedule" }]}]} , { "description": "Closed tx orbit w/manipulj", "code_information": [ { "code": "21401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5192.75, "discounted_cash": 1957,"minimum": 18.16,"maximum": 4154.2,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3011.4, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4154.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2333.84, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2107.98, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1656.27, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2856.01, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1565.93, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2258.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4154.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3575.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3071.63, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1580.98, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1806.84, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 261.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1204.56, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 247, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1557.83, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1550.87, "methodology": "fee schedule" }]}]} , { "description": "Treat mouth roof fracture", "code_information": [ { "code": "21421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10868.5, "discounted_cash": 4132,"minimum": 18.16,"maximum": 8694.76,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3814.55, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 610, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8694.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3260.53, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 610, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4450.31, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7547.76, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8694.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6484.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4768.19, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5977.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4927.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 237, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2543.03, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 671, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 251.22, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3305.94, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6357.58, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3337.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 610, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3496.67, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3274.15, "methodology": "fee schedule" }]}]} , { "description": "Treat dental ridge fracture", "code_information": [ { "code": "21440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10868.5, "discounted_cash": 4132,"minimum": 18.16,"maximum": 8694.76,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5977.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4768.19, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6484.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3274.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3814.55, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3305.94, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8694.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4450.31, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4927.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3496.67, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7547.76, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3260.53, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8694.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6357.58, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3337.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2543.03, "methodology": "fee schedule" }]}]} , { "description": "Treat lower jaw fracture", "code_information": [ { "code": "21450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2213.1, "discounted_cash": 706,"minimum": 18.16,"maximum": 2213.1,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 434.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1217.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2213.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1086.44, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 143.1, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1770.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 841.99, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 570.38, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 663.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 760.51, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 651.86, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 814.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1108.17, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 564.95, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 559.52, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1770.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 597.54, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 135, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1289.83, "methodology": "fee schedule" }]}]} , { "description": "TREAT LOWER JAW FRACTURE", "code_information": [ { "code": "21451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5192.75, "discounted_cash": 1957,"minimum": 18.16,"maximum": 4154.2,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 399.5, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1580.98, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1048.3, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3011.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4154.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2107.98, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 953, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2856.01, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2333.84, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1204.56, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1565.93, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 953, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4154.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1557.83, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1806.84, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1550.87, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1656.27, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3575.15, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 953, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 423.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2258.55, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3071.63, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" }]}]} , { "description": "TREAT LOWER JAW FRACTURE", "code_information": [ { "code": "21453", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20654.7, "discounted_cash": 7516,"minimum": 18.16,"maximum": 16523.8,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6360.1, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 5955.37, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 399.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11795.1, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16523.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8094.67, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11563.8, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 953, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11360.1, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 423.47, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 8961.96, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6196.41, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1048.3, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 953, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 16523.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13728.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8672.86, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6071.01, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 6938.29, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 5781.91, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6013.19, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 953, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 4625.53, "methodology": "fee schedule" }]}]} , { "description": "RESET DISLOCATED JAW", "code_information": [ { "code": "21480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 729.59, "discounted_cash": 302,"minimum": 18.16,"maximum": 729.59,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 28.98, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 583.67, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 30.72, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 569, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 625.9, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 729.59, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 569, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 218.88, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 583.67, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 401.27, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 569, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" }]}]} , { "description": "Reset dislocated jaw", "code_information": [ { "code": "21485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5192.75, "discounted_cash": 1957,"minimum": 18.16,"maximum": 4154.2,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2258.55, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1557.83, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1550.87, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1580.98, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 95.93, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4154.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2856.01, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4154.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3575.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1656.27, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1806.84, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2333.84, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3071.63, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2107.98, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3011.4, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1204.56, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1505.7, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1565.93, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 90.5, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" }]}]} , { "description": "OTHER HEART ASSIST SYSTEM IMPLANT", "code_information": [ { "code": "215", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 40893.2,"maximum": 160324,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 145145, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 88072.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 158912, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 88072.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 90714.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 88072.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 160324, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 92476.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 160324, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 88072.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 88072.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 88072.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 40893.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 135050, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 88072.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 118492, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 114494, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 136513, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 105687, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 125152, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 91595.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 88072.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 88072.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 92476.3, "methodology": "case rate" }]}]} , { "description": "DRAIN NECK/CHEST LESION", "code_information": [ { "code": "21501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "Biopsy of neck/chest", "code_information": [ { "code": "21550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3709, "discounted_cash": 2080,"minimum": 18.16,"maximum": 3709,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3709, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2967.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2967.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1112.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2039.95, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" }]}]} , { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 55748.3,"maximum": 150985,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 83696.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 118909, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 87881.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 129729, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 122292, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 83696.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 83696.4, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 108805, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 83696.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 122292, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 87044.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 83696.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 83696.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 128314, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 112581, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 150985, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 110714, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 86207.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 83696.4, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 87881.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 100436, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 55748.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 83696.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 83696.4, "methodology": "case rate" }]}]} , { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 42092.5,"maximum": 99025,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 85262.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 99025, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 55007.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 57758.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 55007.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 57208.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 42092.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 77987.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 79384.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 55007.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 55007.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 55007.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 66009.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 73837.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 57758.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 55007.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 55007.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 55007.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 79384.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 71510.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 84155.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 55007.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 56658, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 71869.1, "methodology": "case rate" }]}]} , { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 49264.9,"maximum": 88623.6,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 49264.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 76360.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 49264.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 88623.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 66730, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 49264.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 64044.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 59117.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 66081.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 73708.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 51728.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 73708.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 49264.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 49264.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 51235.5, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 50742.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 51728.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 49264.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 49264.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 69796, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 75316.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 53981.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 49264.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 49264.9, "methodology": "case rate" }]}]} , { "description": "Treat sternum fracture", "code_information": [ { "code": "21820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1290, "discounted_cash": 302,"minimum": 18.16,"maximum": 1290,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 64.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1290, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 387, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 61, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 61, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 709.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 61, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 67.1, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 61, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1032, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1032, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 48400.7,"maximum": 119963,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 89449.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 66568.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 69896.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 66568.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 48400.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 66568.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 94477.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 95872.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 86795.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 66568.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 95872.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 66568.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 101950, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 68565.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 66568.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 69896.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 66568.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 66568.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 103181, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 66568.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 69231, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 79881.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 86538.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 119963, "methodology": "case rate" }]}]} , { "description": "BIOPSY SOFT TISSUE OF BACK", "code_information": [ { "code": "21920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" }]}]} , { "description": "Biopsy soft tissue of back", "code_information": [ { "code": "21925", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "Exc back tum deep 5 cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7533, "discounted_cash": 3647,"minimum": 18.16,"maximum": 6661.32,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4143.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2259.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" }]}]} , { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 35537.7,"maximum": 81590.2,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 45381.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 46743.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 45381.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 45381.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 45381.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 47196.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 65022.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 35537.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 60837.4, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 47650.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 64256.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 58996.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 70341.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 45381.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 65022.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 45381.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 54458, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 47650.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 69338.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 81590.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 45381.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 45381.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 45381.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 58866.9, "methodology": "case rate" }]}]} , { "description": "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES ", "code_information": [ { "code": "2201", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13488.2,"maximum": 1.04186e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.92244e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.92244e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.92244e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.04186e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 13488.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.04186e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.92244e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.92244e+007, "methodology": "case rate" }]}]} , { "description": "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES ", "code_information": [ { "code": "2202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20041.6,"maximum": 1.46167e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.46167e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.39207e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.39207e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.39207e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20041.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.46167e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.39207e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.39207e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES ", "code_information": [ { "code": "2203", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 32498.2,"maximum": 2.24626e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.13929e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.24626e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.13929e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 32498.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.13929e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.13929e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.13929e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.24626e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES ", "code_information": [ { "code": "2204", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 64483.4,"maximum": 4.25035e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 64483.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.04795e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.25035e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.04795e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.25035e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.04795e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.04795e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.04795e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 36947.5,"maximum": 72318.3,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 48314.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 56954.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 61459.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 52341.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 40262.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 57604.4, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 42275.5, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 41470.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 40262.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 40262.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 41872.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 57604.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 53923.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 62406.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 36947.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 40262.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 40262.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 40262.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 52150.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 40262.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 40262.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 42275.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 72318.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 40262.4, "methodology": "case rate" }]}]} , { "description": "OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES ", "code_information": [ { "code": "2221", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10241,"maximum": 5.67321e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10241, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.40306e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.67321e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.40306e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.40306e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.67321e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.40306e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.40306e+007, "methodology": "case rate" }]}]} , { "description": "OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES ", "code_information": [ { "code": "2222", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13107,"maximum": 9.94996e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.47615e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.47615e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.47615e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 13107, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.94996e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.47615e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.94996e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.47615e+007, "methodology": "case rate" }]}]} , { "description": "OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES ", "code_information": [ { "code": "2223", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21241,"maximum": 1.50672e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.43497e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.43497e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.50672e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 21241, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.50672e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.43497e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.43497e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.43497e+008, "methodology": "case rate" }]}]} , { "description": "OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES ", "code_information": [ { "code": "2224", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 51822.2,"maximum": 2.91604e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.77718e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.91604e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.77718e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.91604e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.77718e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.77718e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.77718e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 51822.2, "methodology": "case rate" }]}]} , { "description": "OTHER SMALL & LARGE BOWEL PROCEDURES ", "code_information": [ { "code": "2231", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10966.6,"maximum": 7.9551e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.57628e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.57628e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.9551e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.9551e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.57628e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.57628e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.57628e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10966.6, "methodology": "case rate" }]}]} , { "description": "Closed tx vert fx w/o manj", "code_information": [ { "code": "22310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2106, "discounted_cash": 302,"minimum": 18.16,"maximum": 2000,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 197, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1684.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 197, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 197, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 197, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 631.8, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 216.7, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1158.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1684.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 208.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" }]}]} , { "description": "CLOSED TX VERT FX W/MANJ", "code_information": [ { "code": "22315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 4154,"minimum": 18.16,"maximum": 6087.1,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 301, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6087.1, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 301, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 331.1, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 319.06, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 301, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 301, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6087.1, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6087.1, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" }]}]} , { "description": "OTHER SMALL & LARGE BOWEL PROCEDURES ", "code_information": [ { "code": "2232", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14539.3,"maximum": 1.01496e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.66631e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.66631e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 14539.3, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.66631e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.01496e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.01496e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.66631e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.66631e+007, "methodology": "case rate" }]}]} , { "description": "OTHER SMALL & LARGE BOWEL PROCEDURES ", "code_information": [ { "code": "2233", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 24420.6,"maximum": 1.43596e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.36758e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 24420.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.36758e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.36758e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.43596e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.36758e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.43596e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.36758e+008, "methodology": "case rate" }]}]} , { "description": "OTHER SMALL & LARGE BOWEL PROCEDURES ", "code_information": [ { "code": "2234", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 50427.5,"maximum": 2.89226e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 50427.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.75454e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.89226e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.89226e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.75454e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.75454e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.75454e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.75454e+008, "methodology": "case rate" }]}]} , { "description": "PERITONEAL ADHESIOLYSIS ", "code_information": [ { "code": "2241", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12355.1,"maximum": 9.45327e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.45327e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.00311e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.00311e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.45327e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.00311e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.00311e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.00311e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12355.1, "methodology": "case rate" }]}]} , { "description": "PERITONEAL ADHESIOLYSIS ", "code_information": [ { "code": "2242", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16178.2,"maximum": 1.10163e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.04917e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.04917e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.04917e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.04917e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.04917e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.10163e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.10163e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16178.2, "methodology": "case rate" }]}]} , { "description": "PERITONEAL ADHESIOLYSIS ", "code_information": [ { "code": "2243", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 24492.4,"maximum": 1.6005e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 24492.4, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.52429e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.52429e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.52429e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.52429e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.6005e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.6005e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.52429e+008, "methodology": "case rate" }]}]} , { "description": "PERITONEAL ADHESIOLYSIS ", "code_information": [ { "code": "2244", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 44458,"maximum": 2.79767e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.66445e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.79767e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.66445e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 44458, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.66445e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.79767e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.66445e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.66445e+008, "methodology": "case rate" }]}]} , { "description": "PERQ CERVICOTHORACIC INJECT", "code_information": [ { "code": "22510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5944, "discounted_cash": 4154,"minimum": 18.16,"maximum": 5944,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5944, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5944, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5944, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4755.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3269.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1783.2, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4755.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" }]}]} , { "description": "Perq lumbosacral injection", "code_information": [ { "code": "22511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5944, "discounted_cash": 4154,"minimum": 18.16,"maximum": 5944,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4755.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4755.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3269.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5944, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5944, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1783.2, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5944, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" }]}]} , { "description": "VERTEBROPLASTY ADDL INJECT", "code_information": [ { "code": "22512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5944,"minimum": 18.16,"maximum": 4755.2,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4755.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4755.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3269.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1783.2, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" }]}]} , { "description": "Perq vertebral augmentation", "code_information": [ { "code": "22513", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20475, "discounted_cash": 9182,"minimum": 18.16,"maximum": 16771.3,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6142.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11261.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16771.3, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10948.2, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14126.7, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16380, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10595, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14409.2, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 16380, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [ { "code": "22514", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20475, "discounted_cash": 9182,"minimum": 18.16,"maximum": 16771.3,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14409.2, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16771.3, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10595, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6142.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10948.2, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11261.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16380, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14126.7, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 16380, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Perq vertebral augmentation", "code_information": [ { "code": "22515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17652,"minimum": 18.16,"maximum": 14121.6,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 14121.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9708.6, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14121.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5295.6, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "ANAL AND PERINEAL PROCEDURES", "code_information": [ { "code": "2261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6846,"maximum": 5.80924e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.53261e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.53261e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.80924e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.53261e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6846, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.53261e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.80924e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.53261e+007, "methodology": "case rate" }]}]} , { "description": "ANAL AND PERINEAL PROCEDURES", "code_information": [ { "code": "2262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9269.58,"maximum": 7.32551e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.32551e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.97667e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.97667e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.97667e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.32551e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9269.58, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.97667e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.97667e+007, "methodology": "case rate" }]}]} , { "description": "ANAL AND PERINEAL PROCEDURES", "code_information": [ { "code": "2263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15110.4,"maximum": 1.12066e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.0673e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.12066e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15110.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.0673e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.0673e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.0673e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.12066e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.0673e+008, "methodology": "case rate" }]}]} , { "description": "ANAL AND PERINEAL PROCEDURES", "code_information": [ { "code": "2264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 30924,"maximum": 2.13051e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 30924, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.02906e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.13051e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.13051e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.02906e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.02906e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.02906e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.02906e+008, "methodology": "case rate" }]}]} , { "description": "HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL ", "code_information": [ { "code": "2271", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10640.9,"maximum": 8.12857e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10640.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.74149e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.74149e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.12857e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.74149e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.74149e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.12857e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.74149e+007, "methodology": "case rate" }]}]} , { "description": "HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL ", "code_information": [ { "code": "2272", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13517.1,"maximum": 9.92687e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 13517.1, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.45416e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.45416e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.92687e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.45416e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.45416e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.45416e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.92687e+007, "methodology": "case rate" }]}]} , { "description": "HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL ", "code_information": [ { "code": "2273", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21934.1,"maximum": 1.45474e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 21934.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.38547e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.38547e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.38547e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.38547e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.45474e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.45474e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.38547e+008, "methodology": "case rate" }]}]} , { "description": "HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL ", "code_information": [ { "code": "2274", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 45154.8,"maximum": 2.84141e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.7061e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.7061e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.7061e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.7061e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.84141e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 45154.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.84141e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.7061e+008, "methodology": "case rate" }]}]} , { "description": "OTHER CARDIOTHORACIC PROCEDURES WITH MCC", "code_information": [ { "code": "228", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14975.9,"maximum": 82032.6,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 66616.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 58448.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 56697, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 74266.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 43613.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 45793.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 43613.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 78387.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 43613.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 43613.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 43613.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 44921.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 43613.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 67600.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 43613.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 52335.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 45357.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 43613.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 45793.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 14975.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 82032.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 61734.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 43613.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 82032.6, "methodology": "case rate" }]}]} , { "description": "INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES ", "code_information": [ { "code": "2281", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8004.39,"maximum": 6.82694e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.50185e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.50185e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.50185e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.50185e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.50185e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.82694e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8004.39, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.82694e+007, "methodology": "case rate" }]}]} , { "description": "INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES ", "code_information": [ { "code": "2282", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10454.2,"maximum": 8.49733e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.0927e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10454.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.0927e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.49733e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.0927e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.0927e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.0927e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.49733e+007, "methodology": "case rate" }]}]} , { "description": "INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES ", "code_information": [ { "code": "2283", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16058.7,"maximum": 1.18456e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.12815e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.12815e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.12815e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.18456e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.12815e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16058.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.12815e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.18456e+008, "methodology": "case rate" }]}]} , { "description": "INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES ", "code_information": [ { "code": "2284", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 35786.7,"maximum": 2.27478e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.27478e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.16645e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.16645e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.16645e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.16645e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.16645e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.27478e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 35786.7, "methodology": "case rate" }]}]} , { "description": "OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC", "code_information": [ { "code": "229", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23776.3,"maximum": 58113.1,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 27644.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 23776.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 52611.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 36883.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 27644.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 42849, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 27644.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 27644.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 27644.5, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 28473.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 38956.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 29026.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 35937.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 33173.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 27644.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 49465, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 58113.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 29026.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 27644.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 42037.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 28750.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 58113.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 27644.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 27644.5, "methodology": "case rate" }]}]} , { "description": "OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES ", "code_information": [ { "code": "2291", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11065.3,"maximum": 8.18722e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11065.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.79735e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.18722e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.79735e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.79735e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.79735e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.79735e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.18722e+007, "methodology": "case rate" }]}]} , { "description": "OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES ", "code_information": [ { "code": "2292", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15264.3,"maximum": 1.13595e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.08186e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15264.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.13595e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.13595e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.08186e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.08186e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.08186e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.08186e+008, "methodology": "case rate" }]}]} , { "description": "OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES ", "code_information": [ { "code": "2293", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 24866.8,"maximum": 1.70178e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.62074e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.62074e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.70178e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 24866.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.70178e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.62074e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.62074e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.62074e+008, "methodology": "case rate" }]}]} , { "description": "OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES ", "code_information": [ { "code": "2294", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 51611.2,"maximum": 2.96271e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.96271e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.96271e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.82163e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.82163e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.82163e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 51611.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.82163e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.82163e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR SMALL BOWEL PROCEDURES ", "code_information": [ { "code": "2301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8.82008e+007,"maximum": 9.26109e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.82008e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.82008e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.82008e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.26109e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.82008e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.82008e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.26109e+007, "methodology": "case rate" }]}]} , { "description": "MAJOR SMALL BOWEL PROCEDURES ", "code_information": [ { "code": "2302", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.22656e+008,"maximum": 1.28789e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.22656e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.28789e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.22656e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.22656e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.22656e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.28789e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.22656e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR SMALL BOWEL PROCEDURES ", "code_information": [ { "code": "2303", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.8115e+008,"maximum": 1.90207e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.8115e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.8115e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.90207e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.8115e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.8115e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.90207e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.8115e+008, "methodology": "case rate" }]}]} , { "description": "DRAIN SHOULDER LESION", "code_information": [ { "code": "23030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" }]}]} , { "description": "MAJOR SMALL BOWEL PROCEDURES ", "code_information": [ { "code": "2304", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 3.3371e+008,"maximum": 3.50395e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.3371e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.50395e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.3371e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.3371e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.3371e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.50395e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.3371e+008, "methodology": "case rate" }]}]} , { "description": "Biopsy shoulder tissues", "code_information": [ { "code": "23065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "BIOPSY SHOULDER TISSUES", "code_information": [ { "code": "23066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" }]}]} , { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15545.8,"maximum": 126248,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 91049.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 70038.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 70038.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 108559, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 70038.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 126248, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 70038.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 94740.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 104648, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 72139.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 15545.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 94136.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 73540.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 70038.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 104648, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 70038.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 99427.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 70038.4, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 73540.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 107291, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 72839.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 70038.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 84046, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 70038.4, "methodology": "case rate" }]}]} , { "description": "MAJOR LARGE BOWEL PROCEDURES ", "code_information": [ { "code": "2311", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9.54865e+007,"maximum": 1.00261e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.54865e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.54865e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.54865e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.54865e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.00261e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.54865e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.00261e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR LARGE BOWEL PROCEDURES ", "code_information": [ { "code": "2312", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.20856e+008,"maximum": 1.26898e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.20856e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.20856e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.20856e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.20856e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.26898e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.20856e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.26898e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR LARGE BOWEL PROCEDURES ", "code_information": [ { "code": "2313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.75593e+008,"maximum": 1.84373e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.75593e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.84373e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.84373e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.75593e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.75593e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.75593e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.75593e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR LARGE BOWEL PROCEDURES ", "code_information": [ { "code": "2314", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 2.8782e+008,"maximum": 3.02211e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.02211e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.02211e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.8782e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.8782e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.8782e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.8782e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.8782e+008, "methodology": "case rate" }]}]} , { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14989.8,"maximum": 92542.4,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 51428.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 72882.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 51428.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 78646.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 51428.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 53485.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 76873.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 79714.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 54000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 51428.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 51428.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 14989.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 92542.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 54000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 61714.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 69003.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 52971.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 51428.6, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 51428.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 51428.6, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 66857.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 69595.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 51428.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 76873.5, "methodology": "case rate" }]}]} , { "description": "GASTRIC FUNDOPLICATION ", "code_information": [ { "code": "2321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7.44554e+007,"maximum": 7.81782e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.81782e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.44554e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.44554e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.44554e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.81782e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.44554e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.44554e+007, "methodology": "case rate" }]}]} , { "description": "GASTRIC FUNDOPLICATION ", "code_information": [ { "code": "2322", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9.14931e+007,"maximum": 9.60677e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.14931e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.60677e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.14931e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.14931e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.14931e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.14931e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.60677e+007, "methodology": "case rate" }]}]} , { "description": "GASTRIC FUNDOPLICATION ", "code_information": [ { "code": "2323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.37697e+008,"maximum": 1.44582e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.37697e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.37697e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.37697e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.44582e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.37697e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.37697e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.44582e+008, "methodology": "case rate" }]}]} , { "description": "GASTRIC FUNDOPLICATION ", "code_information": [ { "code": "2324", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4.09342e+008,"maximum": 4.29809e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.09342e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.09342e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.29809e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.29809e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.09342e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.09342e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.09342e+008, "methodology": "case rate" }]}]} , { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13329.5,"maximum": 121338,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 103119, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 67327.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 69347.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 104358, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 13329.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 67327.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 95203.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 67327.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 95203.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 90475.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 80793.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 67327.6, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 70693.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 70693.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 67327.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 95560.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 70020.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 67327.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 67327.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 67327.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 86190, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 121338, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 87525.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 67327.6, "methodology": "case rate" }]}]} , { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS ", "code_information": [ { "code": "2331", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6.90833e+007,"maximum": 7.25375e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.90833e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.25375e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.25375e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.90833e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.90833e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.90833e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.90833e+007, "methodology": "case rate" }]}]} , { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS ", "code_information": [ { "code": "2332", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8.80404e+007,"maximum": 9.24424e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.80404e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.80404e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.24424e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.80404e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.80404e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.80404e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.24424e+007, "methodology": "case rate" }]}]} , { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS ", "code_information": [ { "code": "2333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.23298e+008,"maximum": 1.29463e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.23298e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.29463e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.23298e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.23298e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.23298e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.29463e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.23298e+008, "methodology": "case rate" }]}]} , { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS ", "code_information": [ { "code": "2334", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.93326e+008,"maximum": 2.02993e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.93326e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.93326e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.02993e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.93326e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.93326e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.02993e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.93326e+008, "methodology": "case rate" }]}]} , { "description": "INJECTION FOR SHOULDER X-RAY", "code_information": [ { "code": "23350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069,"minimum": 18.16,"maximum": 1069,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1069, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 587.95, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 855.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 320.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 855.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12767.5,"maximum": 80863.7,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 44980.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 44980.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 53976.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 44980.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 44980.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 47229.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 12767.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 44980.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 44980.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 47229.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 63684.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 44980.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 44980.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 80863.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 68721.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 60295.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 44980.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 46779.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 64302, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 64302, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 58214.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 46329.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 58474.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 69719.8, "methodology": "case rate" }]}]} , { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS ", "code_information": [ { "code": "2341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6.33368e+007,"maximum": 6.65036e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.33368e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.33368e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.33368e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.65036e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.33368e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.65036e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.33368e+007, "methodology": "case rate" }]}]} , { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS ", "code_information": [ { "code": "2342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7.67137e+007,"maximum": 8.05494e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.05494e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.67137e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.67137e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.67137e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.67137e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.05494e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.67137e+007, "methodology": "case rate" }]}]} , { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS ", "code_information": [ { "code": "2343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 1.15388e+008,"maximum": 1.21158e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.15388e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.15388e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.21158e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.15388e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.15388e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.21158e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.15388e+008, "methodology": "case rate" }]}]} , { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS ", "code_information": [ { "code": "2344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 2.04047e+008,"maximum": 2.14249e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.04047e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.04047e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.04047e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.14249e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.04047e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.14249e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.04047e+008, "methodology": "case rate" }]}]} , { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14035.4,"maximum": 91484.5,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 50844.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 53386.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 61013.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 50844.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 50844.5, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 52369.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 72049.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 77747.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 50844.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 72524.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 50844.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 50844.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 72524.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 65658.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 68215, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 91484.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 50844.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 66097.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 50844.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 50844.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 52878.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 78809, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 53386.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 14035.4, "methodology": "case rate" }]}]} , { "description": "CLTX CLAVICULAR FX W/O MNPJ", "code_information": [ { "code": "23500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1323, "discounted_cash": 302,"minimum": 18.16,"maximum": 1323,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 74.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1323, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1058.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 727.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 396.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 70.5, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1058.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" }]}]} , { "description": "Cltx clavicular fx w/mnpj", "code_information": [ { "code": "23505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 94.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 100.17, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" }]}]} , { "description": "Cltx strnclav dislc w/o mnpj", "code_information": [ { "code": "23520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 71.02, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 73.7, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 67, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 67, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 67, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 67, "methodology": "fee schedule" }]}]} , { "description": "CLTX STRNCLAV DISLC W/MNPJ", "code_information": [ { "code": "23525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 93, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 98.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Cltx acromclav dislc wo mnpj", "code_information": [ { "code": "23540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1519, "discounted_cash": 302,"minimum": 18.16,"maximum": 1519,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 69.3, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1215.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1519, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 63, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 63, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 455.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 63, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 835.45, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1215.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 66.78, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 63, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" }]}]} , { "description": "CLTX ACROMCLAV DISLC W/MNPJ", "code_information": [ { "code": "23545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 959.2, "discounted_cash": 302,"minimum": 18.16,"maximum": 959.2,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 959.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 287.76, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 767.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 959.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 767.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 959.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 125.08, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 118, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 527.56, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" }]}]} , { "description": "Cltx scapular fx w/o mnpj", "code_information": [ { "code": "23570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1994, "discounted_cash": 302,"minimum": 18.16,"maximum": 1994,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1595.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1595.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 77.38, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1994, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1096.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 80.3, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 598.2, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 73, "methodology": "fee schedule" }]}]} , { "description": "CLTX SCAP FX W/MNPJ +-TRACTJ", "code_information": [ { "code": "23575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 118.72, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" }]}]} , { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13443.5,"maximum": 62868.9,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 35045.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 35045.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 36797.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 53428.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 35045.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 35045.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 36447, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 36797.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 35045.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 42054.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 35045.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 13443.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 49153.5, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 36096.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 46877.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 35045.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 54320, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 45558.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 35045.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 35045.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 49512.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 49153.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 44499.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 62868.9, "methodology": "case rate" }]}]} , { "description": "CLTX PROX HUMRL FX W/O MNPJ", "code_information": [ { "code": "23600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 123.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 116.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Cltx prx hmrl fx mnpj+-tract", "code_information": [ { "code": "23605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10053, "discounted_cash": 2062,"minimum": 18.16,"maximum": 8042.4,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8042.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8042.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5529.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 185, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3015.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 196.1, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" }]}]} , { "description": "CLTX GR HMRL TBRS FX WO MNPJ", "code_information": [ { "code": "23620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 166.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 157, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "Cltx gr hmrl tbrs fx w/mnpj", "code_information": [ { "code": "23625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 157, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 166.42, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" }]}]} , { "description": "Cltx sho dslc w/mnpj wo anes", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 99, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 104.94, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "CLTX SHO DSLC W/MNPJ W/ANES", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843, "discounted_cash": 2062,"minimum": 18.16,"maximum": 5906.7,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 147.34, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2052.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5906.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3763.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4060.86, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2215.01, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5906.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 139, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" }]}]} , { "description": "CLTX SHO DSLC FX GR HMRL TBR", "code_information": [ { "code": "23665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 166.42, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 157, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" }]}]} , { "description": "CLTX SHO DISLC NECK FX MNPJ", "code_information": [ { "code": "23675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1280.83, "discounted_cash": 2062,"minimum": 18.16,"maximum": 1280.83,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1280.83, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1280.83, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 384.25, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 150.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 159.53, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1024.66, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1024.66, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1280.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1280.83, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 704.46, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" }]}]} , { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8780.11,"maximum": 74779.4,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8780.11, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 41621.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 53295.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 54107.6, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 43702.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 41621.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 58868.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 64512.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 42869.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 58892.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 49945.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 41621.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 58868.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 43702.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 41621.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 41621.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 74779.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 41621.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 43286.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 55758.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 63550.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 41621.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 41621.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 41621.2, "methodology": "case rate" }]}]} , { "description": "I&d upr a/e dp absc/hmtma", "code_information": [ { "code": "23930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 3647,"minimum": 18.16,"maximum": 6183.1,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6183.1, "methodology": "fee schedule" }]}]} , { "description": "I&D UPR A/E BURSA", "code_information": [ { "code": "23931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7762.61,"maximum": 43702.7,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 25686.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 25196.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 43702.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 37917.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 37140.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 24463, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 24463, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 34495.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7762.61, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 25441.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 32586.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 31229.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 24463, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 34495.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 24463, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 25686.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 31801.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 24463, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 24463, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 24463, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 24463, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 34418.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 29355.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 24463, "methodology": "case rate" }]}]} , { "description": "DIGESTIVE MALIGNANCY ", "code_information": [ { "code": "2401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6913.9,"maximum": 5.78865e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6913.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.513e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.78865e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.513e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.513e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.78865e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.513e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.513e+007, "methodology": "case rate" }]}]} , { "description": "DIGESTIVE MALIGNANCY ", "code_information": [ { "code": "2402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8861.17,"maximum": 6.60731e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.29267e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8861.17, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.29267e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.29267e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.29267e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.60731e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.29267e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.60731e+007, "methodology": "case rate" }]}]} , { "description": "DIGESTIVE MALIGNANCY ", "code_information": [ { "code": "2403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13053.4,"maximum": 9.36154e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.36154e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.91576e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.36154e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.91576e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.91576e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.91576e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 13053.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.91576e+007, "methodology": "case rate" }]}]} , { "description": "DIGESTIVE MALIGNANCY ", "code_information": [ { "code": "2404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23909.4,"maximum": 1.60475e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.52833e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.52833e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.52833e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.52833e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 23909.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.60475e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.52833e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.60475e+008, "methodology": "case rate" }]}]} , { "description": "BIOPSY ARM/ELBOW SOFT TISSUE", "code_information": [ { "code": "24065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" }]}]} , { "description": "Biopsy arm/elbow soft tissue", "code_information": [ { "code": "24066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7347.07,"maximum": 21621.1,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 17027.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 12307.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 12922.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 12307.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 18323.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 14768.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 21621.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 12922.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 12307.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 12799.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 20239.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 18374.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 12307.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 12307.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 12307.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 12307.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 16121.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 12307.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 15999.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 20239.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 12307.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 12676.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 19076.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7347.07, "methodology": "case rate" }]}]} , { "description": "PEPTIC ULCER & GASTRITIS ", "code_information": [ { "code": "2411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5881.46,"maximum": 4.49763e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.28346e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.28346e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5881.46, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.28346e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.49763e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.49763e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.28346e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.28346e+007, "methodology": "case rate" }]}]} , { "description": "PEPTIC ULCER & GASTRITIS ", "code_information": [ { "code": "2412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7294.63,"maximum": 5.35374e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.35374e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.0988e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7294.63, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.0988e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.0988e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.0988e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.35374e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.0988e+007, "methodology": "case rate" }]}]} , { "description": "PEPTIC ULCER & GASTRITIS ", "code_information": [ { "code": "2413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10962.1,"maximum": 8.09736e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10962.1, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.71178e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.71178e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.71178e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.71178e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.71178e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.09736e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.09736e+007, "methodology": "case rate" }]}]} , { "description": "PEPTIC ULCER & GASTRITIS ", "code_information": [ { "code": "2414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 25614.9,"maximum": 1.65024e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.65024e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.57165e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.57165e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.57165e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 25614.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.65024e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.57165e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.57165e+008, "methodology": "case rate" }]}]} , { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [ { "code": "242", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13510.5,"maximum": 53751,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 42331.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 42372.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 30010.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 46803.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 31211.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 30010.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 30010.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 46516.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 13510.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 40079.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 30010.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 30010.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 30010.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 30010.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 36013.1, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 30010.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 31511.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 53751, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 30911.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 46803.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 30010.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 45679.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 39014.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 31511.5, "methodology": "case rate" }]}]} , { "description": "Rmvl fb upper arm/elbw subq", "code_information": [ { "code": "24200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 777, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 777, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 777, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 854.7, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" }]}]} , { "description": "MAJOR ESOPHAGEAL DISORDERS ", "code_information": [ { "code": "2421", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5801.64,"maximum": 4.04089e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.04089e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.84846e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.84846e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.84846e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5801.64, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.84846e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.04089e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.84846e+007, "methodology": "case rate" }]}]} , { "description": "MAJOR ESOPHAGEAL DISORDERS ", "code_information": [ { "code": "2422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7155.87,"maximum": 5.20148e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.9538e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.9538e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.9538e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.20148e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.9538e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.9538e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7155.87, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.20148e+007, "methodology": "case rate" }]}]} , { "description": "Injection px for elbow arthg", "code_information": [ { "code": "24220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2138,"minimum": 18.16,"maximum": 2000,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1710.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 641.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1710.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1175.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "MAJOR ESOPHAGEAL DISORDERS ", "code_information": [ { "code": "2423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10642.5,"maximum": 7.59132e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.22983e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.22983e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.59132e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.22983e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.22983e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10642.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.22983e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.59132e+007, "methodology": "case rate" }]}]} , { "description": "MAJOR ESOPHAGEAL DISORDERS ", "code_information": [ { "code": "2424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 24915.2,"maximum": 1.64811e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.64811e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.56963e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.56963e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.56963e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.64811e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 24915.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.56963e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.56963e+008, "methodology": "case rate" }]}]} , { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC", "code_information": [ { "code": "243", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15719.4,"maximum": 35432.6,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 20891.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 30112.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 26420.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 30840.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 19896.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 32130.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 32130.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 19896.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 20891.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 19896.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 19896.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 19896.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 19896.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 15719.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 20692.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 27905.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 25865.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 29088.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 35432.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 19896.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 19896.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 19896.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 23876.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 20493.8, "methodology": "case rate" }]}]} , { "description": "OTHER ESOPHAGEAL DISORDERS ", "code_information": [ { "code": "2431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5397.53,"maximum": 4.39281e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5397.53, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.39281e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.18363e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.18363e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.39281e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.18363e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.18363e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.18363e+007, "methodology": "case rate" }]}]} , { "description": "OTHER ESOPHAGEAL DISORDERS ", "code_information": [ { "code": "2432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6593.59,"maximum": 5.22831e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6593.59, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.22831e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.97935e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.97935e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.97935e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.97935e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.22831e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.97935e+007, "methodology": "case rate" }]}]} , { "description": "OTHER ESOPHAGEAL DISORDERS ", "code_information": [ { "code": "2433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9516.6,"maximum": 7.63438e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.27083e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.27083e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.63438e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9516.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.63438e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.27083e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.27083e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.27083e+007, "methodology": "case rate" }]}]} , { "description": "OTHER ESOPHAGEAL DISORDERS ", "code_information": [ { "code": "2434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20948.4,"maximum": 1.44052e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.37192e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.44052e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.37192e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.37192e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.37192e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.37192e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20948.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.44052e+008, "methodology": "case rate" }]}]} , { "description": "Repair elbow deb/attch open", "code_information": [ { "code": "24359", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8913, "discounted_cash": 4154,"minimum": 18.16,"maximum": 7588.12,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2210, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2210, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7130.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7130.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2210, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2673.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC", "code_information": [ { "code": "244", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16048,"maximum": 28461.5,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 24874.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 19257.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 16048, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 16850.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 16048, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 16048, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 16048, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 16048, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 16850.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 24187.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 17606, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 21222.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 16529.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 16689.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 20862.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 16048, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 16048, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 28461.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 16048, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 26627.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 22415, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 24106.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 16048, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 26627.4, "methodology": "case rate" }]}]} , { "description": "DIVERTICULITIS & DIVERTICULOSIS ", "code_information": [ { "code": "2441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5042.04,"maximum": 3.59911e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.59911e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.42772e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.42772e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.42772e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.59911e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5042.04, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.42772e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.42772e+007, "methodology": "case rate" }]}]} , { "description": "DIVERTICULITIS & DIVERTICULOSIS ", "code_information": [ { "code": "2442", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6597.88,"maximum": 4.85393e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.85393e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.85393e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.62279e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6597.88, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.62279e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.62279e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.62279e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.62279e+007, "methodology": "case rate" }]}]} , { "description": "DIVERTICULITIS & DIVERTICULOSIS ", "code_information": [ { "code": "2443", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10014.4,"maximum": 7.64311e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10014.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.64311e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.27915e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.27915e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.64311e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.27915e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.27915e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.27915e+007, "methodology": "case rate" }]}]} , { "description": "DIVERTICULITIS & DIVERTICULOSIS ", "code_information": [ { "code": "2444", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22730.4,"maximum": 1.43134e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.36318e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.36318e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.36318e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 22730.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.36318e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.36318e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.43134e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.43134e+008, "methodology": "case rate" }]}]} , { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 24315,"maximum": 70495,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 60846.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 56696.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 70495, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 40825.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 41218.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 59909.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 52564.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 39255.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 39255.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 47106.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 39255.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 39255.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 55518.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 41218.4, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 51032.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 62625.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 39255.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 39255.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 39255.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 62625.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 24315, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 40433.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 39255.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 39255.7, "methodology": "case rate" }]}]} , { "description": "TREAT HUMERUS FRACTURE", "code_information": [ { "code": "24500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 118.72, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" }]}]} , { "description": "Treat humerus fracture", "code_information": [ { "code": "24505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1421.99, "discounted_cash": 2062,"minimum": 18.16,"maximum": 1421.99,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1137.59, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 782.09, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 163, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1421.99, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 426.6, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 172.78, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 740, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1137.59, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 740, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 814, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 740, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1421.99, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" }]}]} , { "description": "INFLAMMATORY BOWEL DISEASE ", "code_information": [ { "code": "2451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6020.35,"maximum": 4.03714e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.84489e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.03714e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.84489e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.84489e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6020.35, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.84489e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.03714e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.84489e+007, "methodology": "case rate" }]}]} , { "description": "TREAT HUMERUS FRACTURE", "code_information": [ { "code": "24515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19263, "discounted_cash": 16892,"minimum": 18.16,"maximum": 19263,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 15410.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 10594.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14293.7, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 15593.1, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 13384.1, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 19263, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5778.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 19263, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 19263, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 19263, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 19263, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 18192, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 13514, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 13644, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15410.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 10395.4, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 12994.3, "methodology": "fee schedule" }]}]} , { "description": "INFLAMMATORY BOWEL DISEASE ", "code_information": [ { "code": "2452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7226.47,"maximum": 5.33876e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.33876e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7226.47, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.08453e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.08453e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.08453e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.08453e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.33876e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.08453e+007, "methodology": "case rate" }]}]} , { "description": "INFLAMMATORY BOWEL DISEASE ", "code_information": [ { "code": "2453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10878,"maximum": 8.21093e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.21093e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.81993e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.81993e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.81993e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.81993e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.81993e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10878, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.21093e+007, "methodology": "case rate" }]}]} , { "description": "TREAT HUMERUS FRACTURE", "code_information": [ { "code": "24530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 123.5, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 130.91, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" }]}]} , { "description": "Treat humerus fracture", "code_information": [ { "code": "24535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3141.25, "discounted_cash": 2062,"minimum": 18.16,"maximum": 3141.25,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3141.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 206, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1727.69, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3141.25, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 218.36, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2513, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2513, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3141.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 942.38, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "INFLAMMATORY BOWEL DISEASE ", "code_information": [ { "code": "2454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20681.4,"maximum": 1.43858e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.43858e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.37008e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20681.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.43858e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.37008e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.37008e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.37008e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.37008e+008, "methodology": "case rate" }]}]} , { "description": "Treat humerus fracture", "code_information": [ { "code": "24560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 111, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 117.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" }]}]} , { "description": "TREAT HUMERUS FRACTURE", "code_information": [ { "code": "24565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 173.5, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 183.91, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" }]}]} , { "description": "Treat humerus fracture", "code_information": [ { "code": "24576", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 111, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 111, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 122.1, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 111, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 111, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 117.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "TREAT HUMERUS FRACTURE", "code_information": [ { "code": "24577", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1175, "discounted_cash": 2062,"minimum": 18.16,"maximum": 1175,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 183.91, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 940, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 940, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 646.25, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 173.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 352.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1175, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1175, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1175, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1175, "methodology": "fee schedule" }]}]} , { "description": "Treat elbow dislocation", "code_information": [ { "code": "24600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 102.5, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 108.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 102.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 102.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 112.75, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 102.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" }]}]} , { "description": "TREAT ELBOW DISLOCATION", "code_information": [ { "code": "24605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 166.95, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 157.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "GASTROINTESTINAL VASCULAR INSUFFICIENCY ", "code_information": [ { "code": "2461", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6332.72,"maximum": 4.16506e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.16506e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.96672e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.96672e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.96672e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.16506e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.96672e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6332.72, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.96672e+007, "methodology": "case rate" }]}]} , { "description": "GASTROINTESTINAL VASCULAR INSUFFICIENCY ", "code_information": [ { "code": "2462", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7605.27,"maximum": 5.26138e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.01084e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.26138e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.26138e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.01084e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.01084e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.01084e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7605.27, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.01084e+007, "methodology": "case rate" }]}]} , { "description": "TREAT ELBOW FRACTURE", "code_information": [ { "code": "24620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 148.93, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 140.5, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" }]}]} , { "description": "GASTROINTESTINAL VASCULAR INSUFFICIENCY ", "code_information": [ { "code": "2463", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11495.9,"maximum": 7.81283e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.81283e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.44079e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.44079e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.44079e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11495.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.81283e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.44079e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.44079e+007, "methodology": "case rate" }]}]} , { "description": "Treat elbow fracture", "code_information": [ { "code": "24635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26107.8, "discounted_cash": 9182,"minimum": 18.16,"maximum": 20886.3,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10595, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 474.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14409.2, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20886.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14126.7, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10948.2, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 20886.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7832.35, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16771.3, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 448, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 14359.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "GASTROINTESTINAL VASCULAR INSUFFICIENCY ", "code_information": [ { "code": "2464", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23251.4,"maximum": 1.28951e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.22811e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 23251.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.28951e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.28951e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.22811e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.22811e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.22811e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.22811e+008, "methodology": "case rate" }]}]} , { "description": "TREAT ELBOW DISLOCATION", "code_information": [ { "code": "24640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1175, "discounted_cash": 302,"minimum": 18.16,"maximum": 1175,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 646.25, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 352.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1175, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 56.18, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 53, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 940, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 940, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "Treat radius fracture", "code_information": [ { "code": "24650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 103, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 109.18, "methodology": "fee schedule" }]}]} , { "description": "TREAT RADIUS FRACTURE", "code_information": [ { "code": "24655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2834.19, "discounted_cash": 2062,"minimum": 18.16,"maximum": 2834.19,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 850.26, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2834.19, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2267.35, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 118.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2834.19, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2267.35, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 2834.19, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1558.8, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 125.61, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "Treat ulnar fracture", "code_information": [ { "code": "24670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 106, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 100, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "TREAT ULNAR FRACTURE", "code_information": [ { "code": "24675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 182.5, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 193.45, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" }]}]} , { "description": "INTESTINAL OBSTRUCTION ", "code_information": [ { "code": "2471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4887.58,"maximum": 3.29086e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4887.58, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.29086e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.13416e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.13416e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.13416e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.13416e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.13416e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.29086e+007, "methodology": "case rate" }]}]} , { "description": "INTESTINAL OBSTRUCTION ", "code_information": [ { "code": "2472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6286.08,"maximum": 4.32604e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6286.08, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.12004e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.32604e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.12004e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.12004e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.12004e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.12004e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.32604e+007, "methodology": "case rate" }]}]} , { "description": "INTESTINAL OBSTRUCTION ", "code_information": [ { "code": "2473", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9966.26,"maximum": 6.93115e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.60109e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.93115e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.60109e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.60109e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.93115e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.60109e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9966.26, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.60109e+007, "methodology": "case rate" }]}]} , { "description": "INTESTINAL OBSTRUCTION ", "code_information": [ { "code": "2474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22774.9,"maximum": 1.36926e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.30405e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.30405e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.36926e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.30405e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.30405e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 22774.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.30405e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.36926e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS ", "code_information": [ { "code": "2481", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5330,"maximum": 3.71143e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.53469e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.71143e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.71143e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5330, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.53469e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.53469e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.53469e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.53469e+007, "methodology": "case rate" }]}]} , { "description": "MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS ", "code_information": [ { "code": "2482", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7332.56,"maximum": 4.9962e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.75828e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7332.56, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.9962e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.75828e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.75828e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.75828e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.75828e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.9962e+007, "methodology": "case rate" }]}]} , { "description": "MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS ", "code_information": [ { "code": "2483", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11022.6,"maximum": 7.67119e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.30589e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11022.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.30589e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.30589e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.67119e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.67119e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.30589e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.30589e+007, "methodology": "case rate" }]}]} , { "description": "MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS ", "code_information": [ { "code": "2484", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23466.9,"maximum": 1.48282e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.48282e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.41221e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.48282e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.41221e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.41221e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 23466.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.41221e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.41221e+008, "methodology": "case rate" }]}]} , { "description": "OTHER GASTROENTERITIS, NAUSEA & VOMITING ", "code_information": [ { "code": "2491", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4402.94,"maximum": 3.48991e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.48991e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.32372e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.32372e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.32372e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.48991e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4402.94, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.32372e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.32372e+007, "methodology": "case rate" }]}]} , { "description": "OTHER GASTROENTERITIS, NAUSEA & VOMITING ", "code_information": [ { "code": "2492", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5351.4,"maximum": 4.21997e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.01901e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.01901e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.01901e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.01901e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.01901e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.21997e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.21997e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5351.4, "methodology": "case rate" }]}]} , { "description": "OTHER GASTROENTERITIS, NAUSEA & VOMITING ", "code_information": [ { "code": "2493", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7593.81,"maximum": 6.29844e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.99851e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.99851e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.99851e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7593.81, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.99851e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.99851e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.29844e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.29844e+007, "methodology": "case rate" }]}]} , { "description": "OTHER GASTROENTERITIS, NAUSEA & VOMITING ", "code_information": [ { "code": "2494", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 17359.1,"maximum": 1.29544e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 17359.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.29544e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.23375e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.29544e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.23375e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.23375e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.23375e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.23375e+008, "methodology": "case rate" }]}]} , { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "250", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13840.7,"maximum": 36571.4,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 26683.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 21551.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 20525.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 20525.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 32533.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 20525.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 24630.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 31814.7, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 36571.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 20525.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 27269.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 20525.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 13840.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 20525.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 28802, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 20525.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 21141.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 20525.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 20525.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 21551.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 32533.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 29453.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 31079.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 21346.7, "methodology": "case rate" }]}]} , { "description": "INCISION OF TENDON SHEATH", "code_information": [ { "code": "25000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7233, "discounted_cash": 2062,"minimum": 18.16,"maximum": 5786.4,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 550, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 605, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3978.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5786.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2169.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 550, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5786.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 550, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" }]}]} , { "description": "DRAINAGE OF FOREARM LESION", "code_information": [ { "code": "25028", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3581.2, "discounted_cash": 4154,"minimum": 18.16,"maximum": 3581.2,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3581.2, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3581.2, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2864.96, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3581.2, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1969.66, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1074.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 3581.2, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3581.2, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 3581.2, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2864.96, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3581.2, "methodology": "fee schedule" }]}]} , { "description": "Drainage of forearm bursa", "code_information": [ { "code": "25031", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" }]}]} , { "description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [ { "code": "25065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "Biopsy forearm soft tissues", "code_information": [ { "code": "25066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "251", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13964.2,"maximum": 24687.4,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 21254.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14522.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13964.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13964.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 19442.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 21254.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 18408, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13964.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13964.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13964.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 15804.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 16757, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 24687.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 21644.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 20980.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13964.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 19242.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13964.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13964.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14662.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13964.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 18153.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 14662.4, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 14383.1, "methodology": "case rate" }]}]} , { "description": "ABDOMINAL PAIN ", "code_information": [ { "code": "2511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4999.31,"maximum": 3.88614e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.88614e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.70108e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 4999.31, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.70108e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.70108e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.88614e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.70108e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.70108e+007, "methodology": "case rate" }]}]} , { "description": "Remove wrist tendon lesion", "code_information": [ { "code": "25111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 7130.4,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2673.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 854, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 939.4, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 939.4, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7130.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 854, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 854, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 854, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 854, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7130.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 854, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4902.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" }]}]} , { "description": "ABDOMINAL PAIN ", "code_information": [ { "code": "2512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6197.87,"maximum": 4.73225e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.50691e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.50691e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.50691e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6197.87, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.73225e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.50691e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.50691e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.73225e+007, "methodology": "case rate" }]}]} , { "description": "ABDOMINAL PAIN ", "code_information": [ { "code": "2513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8375,"maximum": 6.38455e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.08052e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.08052e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.08052e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8375, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.38455e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.08052e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.38455e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.08052e+007, "methodology": "case rate" }]}]} , { "description": "ABDOMINAL PAIN ", "code_information": [ { "code": "2514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16041.2,"maximum": 1.09121e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.09121e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.09121e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.03925e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.03925e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16041.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.03925e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.03925e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.03925e+008, "methodology": "case rate" }]}]} , { "description": "OTHER VASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "252", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12503.9,"maximum": 52175.1,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 45168.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 52175.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 29140.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 34969, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 44340.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 37013.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 29140.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 29140.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 37883, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 30597.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 12503.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 29140.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 40883.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 30306.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 38904.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 29140.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 29140.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 29140.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 29140.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 30015, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 29140.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 30597.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 40883.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 41090.8, "methodology": "case rate" }]}]} , { "description": "MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE ", "code_information": [ { "code": "2521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5443.27,"maximum": 4.41277e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.20264e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5443.27, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.41277e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.20264e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.20264e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.20264e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.41277e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.20264e+007, "methodology": "case rate" }]}]} , { "description": "MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE ", "code_information": [ { "code": "2522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7311.29,"maximum": 5.491e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.22953e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.22953e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.491e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7311.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.22953e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.22953e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.22953e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.491e+007, "methodology": "case rate" }]}]} , { "description": "MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE ", "code_information": [ { "code": "2523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11210.1,"maximum": 8.34446e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11210.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.94711e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.94711e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.34446e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.34446e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.94711e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.94711e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.94711e+007, "methodology": "case rate" }]}]} , { "description": "MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE ", "code_information": [ { "code": "2524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 25020.5,"maximum": 1.67688e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.67688e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 25020.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.59703e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.59703e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.59703e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.59703e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.59703e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.67688e+008, "methodology": "case rate" }]}]} , { "description": "INJECTION FOR WRIST XRAY", "code_information": [ { "code": "25246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069,"minimum": 18.16,"maximum": 1069,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 320.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 855.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 855.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 587.95, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1069, "methodology": "case rate" }]}]} , { "description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "253", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13334.4,"maximum": 39687.5,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 22246.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 32626.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 28919.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 32626.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 22246.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 39687.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 22246.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 22246.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 23358.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 29537.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 29592.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 22246.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 22913.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 23135.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 33728.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 31256.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 34481.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 26695.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 13334.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 22246.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 22246.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 22246.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 22246.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 23358.4, "methodology": "case rate" }]}]} , { "description": "OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE ", "code_information": [ { "code": "2531", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5497.21,"maximum": 4.0908e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.0908e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.896e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.896e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.896e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.896e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.0908e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.896e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5497.21, "methodology": "case rate" }]}]} , { "description": "OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE ", "code_information": [ { "code": "2532", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7073.42,"maximum": 5.19649e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.94904e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.94904e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.19649e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.94904e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.19649e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.94904e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.94904e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7073.42, "methodology": "case rate" }]}]} , { "description": "OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE ", "code_information": [ { "code": "2533", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10563.3,"maximum": 7.78164e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10563.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.41108e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.41108e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.78164e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.41108e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.41108e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.78164e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.41108e+007, "methodology": "case rate" }]}]} , { "description": "OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE ", "code_information": [ { "code": "2534", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21882,"maximum": 1.42436e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.42436e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.42436e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.35653e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.35653e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.35653e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 21882, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.35653e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.35653e+008, "methodology": "case rate" }]}]} , { "description": "OTHER VASCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "254", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15237.1,"maximum": 26993,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 15237.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 23617.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 18716.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 21258.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 26993, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 15237.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 18284.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15237.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 15237.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 15237.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22939.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 19808.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 22895.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 15237.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 20727.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15237.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 20127.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 15999, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 15999, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 15237.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 15694.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 15237.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 15846.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 22895.1, "methodology": "case rate" }]}]} , { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES ", "code_information": [ { "code": "2541", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5156.58,"maximum": 3.99159e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.80151e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5156.58, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.80151e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.99159e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.80151e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.80151e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.99159e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.80151e+007, "methodology": "case rate" }]}]} , { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES ", "code_information": [ { "code": "2542", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6883.86,"maximum": 5.10165e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.85871e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.85871e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.85871e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.10165e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.85871e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.85871e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.10165e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6883.86, "methodology": "case rate" }]}]} , { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES ", "code_information": [ { "code": "2543", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10004.9,"maximum": 7.64685e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.28272e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.28272e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.64685e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10004.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.28272e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.28272e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.28272e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.64685e+007, "methodology": "case rate" }]}]} , { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES ", "code_information": [ { "code": "2544", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21454.9,"maximum": 1.39278e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.32646e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.39278e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.32646e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 21454.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.32646e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.39278e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.32646e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.32646e+008, "methodology": "case rate" }]}]} , { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "255", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7919.97,"maximum": 42741.3,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 28931, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 23932.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 31956.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 23932.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 31111.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 28718.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 31956.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 37094.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 33661.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 23932.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 25128.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 23932.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 23932.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 36323.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 23932.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 25128.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 31869.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 24889.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7919.97, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 24650.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 23932.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 42741.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 23932.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 23932.2, "methodology": "case rate" }]}]} , { "description": "Treat fracture of radius", "code_information": [ { "code": "25500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 83.21, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 78.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "TREAT FRACTURE OF RADIUS", "code_information": [ { "code": "25505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 619, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 619, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 619, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 680.9, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 145, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 153.7, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" }]}]} , { "description": "TREAT FRACTURE OF RADIUS", "code_information": [ { "code": "25520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" }]}]} , { "description": "Treat fracture of ulna", "code_information": [ { "code": "25530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 977.75, "discounted_cash": 302,"minimum": 18.16,"maximum": 977.75,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 114.48, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 293.32, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 977.75, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 108, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 782.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 537.76, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 782.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "TREAT FRACTURE OF ULNA", "code_information": [ { "code": "25535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1856.68, "discounted_cash": 302,"minimum": 18.16,"maximum": 1856.68,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 557, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1856.68, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1021.17, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1485.34, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 160.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 170.13, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1485.34, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [ { "code": "25560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 121.37, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 114.5, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat fracture radius & ulna", "code_information": [ { "code": "25565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1856.68, "discounted_cash": 2062,"minimum": 18.16,"maximum": 1856.68,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1856.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1856.68, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1856.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 557, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 688, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1021.17, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1856.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1856.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1856.68, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 200.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 688, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1856.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1856.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1485.34, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 756.8, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1485.34, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 212.53, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" }]}]} , { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [ { "code": "256", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6613.13,"maximum": 25508.8,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 14417.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6613.13, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 14417.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 14417.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 22134.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 14417.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 15138.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 14417.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 14417.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 17301.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 14850.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 18743, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 14417.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20089.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 22347.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 15138.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 25508.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 19020.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14994.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 20039, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 21678.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 14417.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 22134.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 14417.7, "methodology": "case rate" }]}]} , { "description": "TREAT FRACTURE RADIUS/ULNA", "code_information": [ { "code": "25600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326, "discounted_cash": 302,"minimum": 18.16,"maximum": 326,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 121.37, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 326, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 260.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 114.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 326, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 179.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 326, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 260.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 97.8, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "Treat fracture radius/ulna", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2834.19, "discounted_cash": 2062,"minimum": 18.16,"maximum": 2834.19,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1558.8, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2834.19, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 175.96, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2267.35, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 2834.19, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 166, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1093.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 994, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 850.26, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 994, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2267.35, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 994, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2834.19, "methodology": "fee schedule" }]}]} , { "description": "TREAT FX RAD INTRAARTICUL", "code_information": [ { "code": "25608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11493, "discounted_cash": 9182,"minimum": 18.16,"maximum": 11493,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10948.2, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6321.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3447.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10595, "methodology": "fee schedule" }]}]} , { "description": "TREAT WRIST BONE FRACTURE", "code_information": [ { "code": "25622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 122, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 129.32, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" }]}]} , { "description": "Treat wrist bone fracture", "code_information": [ { "code": "25624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 164.3, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 155, "methodology": "fee schedule" }]}]} , { "description": "TREAT WRIST BONE FRACTURE", "code_information": [ { "code": "25628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26107.8, "discounted_cash": 9182,"minimum": 18.16,"maximum": 20886.3,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14126.7, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 20886.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7832.35, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10595, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14409.2, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20886.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10948.2, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16771.3, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 14359.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" }]}]} , { "description": "Treat wrist bone fracture", "code_information": [ { "code": "25630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "TREAT WRIST BONE FRACTURE", "code_information": [ { "code": "25635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1491.25, "discounted_cash": 2062,"minimum": 18.16,"maximum": 1491.25,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 145, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 447.38, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 153.7, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1193, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 820.19, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1491.25, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1193, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1491.25, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" }]}]} , { "description": "TREAT WRIST BONE FRACTURE", "code_information": [ { "code": "25650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 154.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 146, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" }]}]} , { "description": "Treat wrist dislocation", "code_information": [ { "code": "25660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 110.24, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 104, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" }]}]} , { "description": "TREAT WRIST DISLOCATION", "code_information": [ { "code": "25675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 110.24, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 104, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" }]}]} , { "description": "TREAT WRIST FRACTURE", "code_information": [ { "code": "25680", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1722, "discounted_cash": 302,"minimum": 18.16,"maximum": 1722,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 516.6, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1722, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 947.1, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 237.44, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1377.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1377.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1722, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 224, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1722, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "TREAT WRIST DISLOCATION", "code_information": [ { "code": "25690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10035.3, "discounted_cash": 2062,"minimum": 18.16,"maximum": 8028.2,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8028.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5519.39, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8028.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 241.68, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3010.57, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 228, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" }]}]} , { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC", "code_information": [ { "code": "257", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5998.56,"maximum": 15417,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 15417, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 13045.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 5998.56, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9288.06, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8845.77, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 14409.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9199.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 13710.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13102, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 9288.06, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8845.77, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8845.77, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8845.77, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11495.6, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11499.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8845.77, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 12141.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8845.77, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 14409.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8845.77, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8845.77, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10614.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9111.14, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8845.77, "methodology": "case rate" }]}]} , { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11798.3,"maximum": 42137.7,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 24778.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 11798.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 23598.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 33969, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 35810.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 23598.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 36578.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 37521.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 23598.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 23598.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 23598.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 23598.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 30678.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 31419.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 23598.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 33185.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 37521.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 42137.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 24306.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 28318.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 24542.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 24778.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 23598.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 23598.9, "methodology": "case rate" }]}]} , { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15512.5,"maximum": 29038.7,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 16366.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21276.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 26456.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 17021.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 16366.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 17185, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 16857.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 25368.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 16366.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 16366.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 17185, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 16366.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 19640, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 16366.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 24678.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 15512.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 26456.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 16366.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 22869.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 23951.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 29038.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 16366.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 16366.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 21652.6, "methodology": "case rate" }]}]} , { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11340.1,"maximum": 51574.6,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 28809.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 29673.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 38456.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 43830.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 45346.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 28809.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 11340.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 28809.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 40617.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 34571.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 30249.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 28809.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 41053.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 51574.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 30249.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 28809.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 29961.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 28809.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 37452, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 28809.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 28809.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 28809.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 45346.8, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 44654.3, "methodology": "case rate" }]}]} , { "description": "MAJOR PANCREAS, LIVER & SHUNT PROCEDURES ", "code_information": [ { "code": "2601", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16091.4,"maximum": 1.33431e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.27078e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.27078e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.33431e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.27078e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.27078e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.27078e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.33431e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16091.4, "methodology": "case rate" }]}]} , { "description": "Drainage of finger abscess", "code_information": [ { "code": "26010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 891.44, "discounted_cash": 256,"minimum": 18.16,"maximum": 891.44,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 205.57, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 891.44, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 237.19, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 158.13, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 276.72, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 395.32, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 713.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 891.44, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 403.23, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 296.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 267.43, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 891.44, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 203.59, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 713.15, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 207.54, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469.33, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 490.29, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 306.37, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 217.43, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 197.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "DRAINAGE OF FINGER ABSCESS", "code_information": [ { "code": "26011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5155.81, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4124.65,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 700, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4124.65, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2835.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 770, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1546.74, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 700, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4124.65, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 700, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" }]}]} , { "description": "MAJOR PANCREAS, LIVER & SHUNT PROCEDURES ", "code_information": [ { "code": "2602", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21264.2,"maximum": 1.6362e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.55828e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.55828e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.55828e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.6362e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.6362e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.55828e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.55828e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 21264.2, "methodology": "case rate" }]}]} , { "description": "DRAINAGE OF PALM BURSA", "code_information": [ { "code": "26025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6749.7, "discounted_cash": 4154,"minimum": 18.16,"maximum": 6749.7,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6749.7, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3712.34, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5399.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2024.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5399.76, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" }]}]} , { "description": "MAJOR PANCREAS, LIVER & SHUNT PROCEDURES ", "code_information": [ { "code": "2603", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 33374.2,"maximum": 2.26435e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.26435e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.15653e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.26435e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.15653e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.15653e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.15653e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 33374.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.15653e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR PANCREAS, LIVER & SHUNT PROCEDURES ", "code_information": [ { "code": "2604", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 67604.5,"maximum": 4.39331e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.39331e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.1841e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.1841e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.1841e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 67604.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.1841e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.1841e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.39331e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12387.1,"maximum": 29275.2,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 16497.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 16497.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 29275.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 24879.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 19796.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 22769.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 25150.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 16497.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 16497.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 16497.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 16497.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 21828.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 16497.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 25570.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 17157.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 17322.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 23055.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21446.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 16497.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 16497.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 17322.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 16992.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 25150.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 12387.1, "methodology": "case rate" }]}]} , { "description": "MAJOR BILIARY TRACT PROCEDURES ", "code_information": [ { "code": "2611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13383,"maximum": 1.04179e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.04179e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.92184e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.92184e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 13383, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.92184e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.92184e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.04179e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.92184e+007, "methodology": "case rate" }]}]} , { "description": "MAJOR BILIARY TRACT PROCEDURES ", "code_information": [ { "code": "2612", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 18621.2,"maximum": 1.4188e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.35124e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.35124e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.35124e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.4188e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.4188e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.35124e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18621.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.35124e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR BILIARY TRACT PROCEDURES ", "code_information": [ { "code": "2613", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 28160,"maximum": 1.97009e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.97009e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.97009e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.87627e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 28160, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.87627e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.87627e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.87627e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.87627e+008, "methodology": "case rate" }]}]} , { "description": "MAJOR BILIARY TRACT PROCEDURES ", "code_information": [ { "code": "2614", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 51734.6,"maximum": 3.80814e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.6268e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.80814e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.6268e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.6268e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.6268e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.80814e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.6268e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 51734.6, "methodology": "case rate" }]}]} , { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14465.8,"maximum": 25595.9,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 14465.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20158.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 25595.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 15189.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 19085.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 18805.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 14465.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 17359, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 14899.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 18715.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 15189.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 14465.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 14465.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 15528.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 14465.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 20672.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 14465.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 14465.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 14465.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 21752.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 20672.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 22422, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 15044.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 14465.8, "methodology": "case rate" }]}]} , { "description": "VEIN LIGATION AND STRIPPING", "code_information": [ { "code": "263", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11778.7,"maximum": 43951.6,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 24600.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 24600.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 24600.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 25830.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 38130.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 24600.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 24600.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 29520.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 37352, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 24600.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 24600.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 34614.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 30118.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 31980.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 30118.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 25830.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 43951.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 27267.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 11778.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 25338.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 32772.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 24600.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 24600.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 25584.5, "methodology": "case rate" }]}]} , { "description": "CHOLECYSTECTOMY", "code_information": [ { "code": "2631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9966.07,"maximum": 7.99379e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.61313e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.61313e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9966.07, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.61313e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.61313e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.99379e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.61313e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.99379e+007, "methodology": "case rate" }]}]} , { "description": "CHOLECYSTECTOMY", "code_information": [ { "code": "2632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12611.7,"maximum": 9.71908e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.71908e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.25627e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.25627e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12611.7, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.25627e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.25627e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.71908e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.25627e+007, "methodology": "case rate" }]}]} , { "description": "CHOLECYSTECTOMY", "code_information": [ { "code": "2633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 17180.6,"maximum": 1.2293e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.17076e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.2293e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.17076e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.17076e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 17180.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.17076e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.17076e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.2293e+008, "methodology": "case rate" }]}]} , { "description": "CHOLECYSTECTOMY", "code_information": [ { "code": "2634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 36410.3,"maximum": 2.51594e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 36410.3, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.39614e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.51594e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.51594e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.39614e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.39614e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.39614e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.39614e+008, "methodology": "case rate" }]}]} , { "description": "OTHER CIRCULATORY SYSTEM O.R. PROCEDURES", "code_information": [ { "code": "264", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9752.58,"maximum": 50809.2,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 28386.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 28386.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 29806, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 28386.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 43999.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 36902.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 40015, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 28386.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 39628.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 29238.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 50809.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 28386.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 35876.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 39628.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 9752.58, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 43179.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 28386.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 34064, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 28386.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 28386.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 29806, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 29522.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 37885.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 28386.7, "methodology": "case rate" }]}]} , { "description": "OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES ", "code_information": [ { "code": "2641", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 13271.2,"maximum": 9.78149e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.3157e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.78149e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.3157e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.3157e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 13271.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.3157e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.78149e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.3157e+007, "methodology": "case rate" }]}]} , { "description": "Repair hand tendon", "code_information": [ { "code": "26410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8423.44, "discounted_cash": 2062,"minimum": 18.16,"maximum": 6738.75,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 888.8, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 808, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4632.89, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2527.03, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 808, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6738.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6738.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 808, "methodology": "fee schedule" }]}]} , { "description": "Repair finger tendon", "code_information": [ { "code": "26418", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8423.44, "discounted_cash": 2062,"minimum": 18.16,"maximum": 6738.75,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 809, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6738.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6738.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 809, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 889.9, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2527.03, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 809, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4632.89, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" }]}]} , { "description": "OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES ", "code_information": [ { "code": "2642", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 16255,"maximum": 1.08073e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.02927e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.02927e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.02927e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.02927e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.02927e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 16255, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.08073e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.08073e+008, "methodology": "case rate" }]}]} , { "description": "REPAIR/GRAFT FINGER TENDON", "code_information": [ { "code": "26420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1160.75, "discounted_cash": 4154,"minimum": 1160.75,"maximum": 1160.75,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1160.75, "methodology": "fee schedule" }]}]} , { "description": "OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES ", "code_information": [ { "code": "2643", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 25148.6,"maximum": 1.66128e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.66128e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.58217e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.58217e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.66128e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 25148.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.58217e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.58217e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.58217e+008, "methodology": "case rate" }]}]} , { "description": "OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES ", "code_information": [ { "code": "2644", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 54620.3,"maximum": 3.53477e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.36645e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.36645e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.36645e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.36645e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 54620.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.53477e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.36645e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.53477e+008, "methodology": "case rate" }]}]} , { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15660.7,"maximum": 54980,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 30689.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 43299.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 46724.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 30689.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 15660.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 31610.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 47568.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 30689.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 32223.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 35405.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 39108.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 30689.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 54980, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 30689.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 31917, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 30689.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 39108.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 39896.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 32223.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 30689.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 36827.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 30689.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 40995.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 30689.5, "methodology": "case rate" }]}]} , { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 53983.9,"maximum": 97170.6,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 53983.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 81177.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 53983.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 64780.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 53983.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 53983.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 56683.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 53983.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 72454.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 53983.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 83675.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 76527.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 97170.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 89667, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 53983.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 55603.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 56143.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 89667, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 53983.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 55015.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 53983.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 56683.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 70179.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 82579.7, "methodology": "case rate" }]}]} , { "description": "Treat metacarpal fracture", "code_information": [ { "code": "26600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1059, "discounted_cash": 302,"minimum": 18.16,"maximum": 1059,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 317.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 69.5, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 582.45, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1059, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 847.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 73.67, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 847.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT METACARPAL FRACTURE", "code_information": [ { "code": "26605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1021.25, "discounted_cash": 302,"minimum": 18.16,"maximum": 1021.25,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 817, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 106, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 306.38, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 561.69, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 817, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1021.25, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1021.25, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1021.25, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 112.36, "methodology": "fee schedule" }]}]} , { "description": "Treat metacarpal fracture", "code_information": [ { "code": "26615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13563.9, "discounted_cash": 4154,"minimum": 2556.63,"maximum": 7588.12,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "TREAT THUMB DISLOCATION", "code_information": [ { "code": "26641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 40.81, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 38.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat thumb fracture", "code_information": [ { "code": "26645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 89, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 94.34, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" }]}]} , { "description": "TREAT HAND DISLOCATION", "code_information": [ { "code": "26670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 51.41, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 53.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 48.5, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 48.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 48.5, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 48.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" }]}]} , { "description": "Treat hand dislocation", "code_information": [ { "code": "26675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 77.91, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 73.5, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 42251.7,"maximum": 75921.3,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 42251.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 44364.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 56610.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 42251.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 60934.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 64521.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 66087.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 50702, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 42251.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 42251.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 44364.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 43519.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 54927.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 42251.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 42251.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 42251.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 43941.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 59792.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 42251.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 72998.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 42251.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 72998.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 75921.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 65490.1, "methodology": "case rate" }]}]} , { "description": "TREAT KNUCKLE DISLOCATION", "code_information": [ { "code": "26700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 39, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 39, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 39, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 42.9, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 41.34, "methodology": "fee schedule" }]}]} , { "description": "Treat knuckle dislocation", "code_information": [ { "code": "26705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 73.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 77.91, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" }]}]} , { "description": "Treat knuckle dislocation", "code_information": [ { "code": "26715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13563.9, "discounted_cash": 4154,"minimum": 2556.63,"maximum": 7588.12,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" }]}]} , { "description": "TREAT FINGER FRACTURE EACH", "code_information": [ { "code": "26720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 283, "discounted_cash": 302,"minimum": 18.16,"maximum": 283,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 283, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 283, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 226.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 283, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 283, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 226.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 155.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 84.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 283, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 283, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 56, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 283, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 283, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 283, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 59.36, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 283, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 283, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 283, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 283, "methodology": "case rate" }]}]} , { "description": "Treat finger fracture each", "code_information": [ { "code": "26725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 731, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 804.1, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 81.62, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 731, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 731, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 77, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" }]}]} , { "description": "Treat finger fracture each", "code_information": [ { "code": "26735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 4154,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 900, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 900, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 900, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 224, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 990, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "TREAT FINGER FRACTURE EACH", "code_information": [ { "code": "26740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 333, "discounted_cash": 302,"minimum": 18.16,"maximum": 333,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 333, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 99.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 183.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 333, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 266.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 41.34, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 333, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 266.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "Treat finger fracture each", "code_information": [ { "code": "26742", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326, "discounted_cash": 2062,"minimum": 18.16,"maximum": 326,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 326, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 97.8, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 260.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 77.91, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 260.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 73.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 326, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 179.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 326, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 326, "methodology": "fee schedule" }]}]} , { "description": "TREAT FINGER FRACTURE EACH", "code_information": [ { "code": "26746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4389, "discounted_cash": 4154,"minimum": 2556.63,"maximum": 4389,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 4389, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4389, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4389, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4389, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4389, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4389, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "Treat finger fracture each", "code_information": [ { "code": "26750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 48, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 48, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 48, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 52.8, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 50.88, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 48, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" }]}]} , { "description": "TREAT FINGER FRACTURE EACH", "code_information": [ { "code": "26755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 77.38, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" }]}]} , { "description": "TREAT FINGER FRACTURE EACH", "code_information": [ { "code": "26765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 4154,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 832, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 178, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 832, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 188.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 832, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 915.2, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" }]}]} , { "description": "Treat finger dislocation", "code_information": [ { "code": "26770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 989.44, "discounted_cash": 302,"minimum": 18.16,"maximum": 989.44,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 36.5, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 989.44, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 989.44, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 36.5, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 544.19, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 38.69, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 989.44, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 296.83, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 791.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 791.55, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 36.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 36.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" }]}]} , { "description": "TREAT FINGER DISLOCATION", "code_information": [ { "code": "26775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1103.75, "discounted_cash": 344,"minimum": 18.16,"maximum": 1103.75,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1103.75, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 607.06, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 397.73, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 530.3, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 629.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 883, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 273.1, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 883, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 318.18, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 331.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1103.75, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 371.21, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 275.76, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 278.41, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 212.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 540.91, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 291.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 410.98, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1103.75, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" }]}]} , { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22432.6,"maximum": 106639,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 59211.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 75698.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 83614.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 22432.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 90626, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 83983.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 59211.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 59211.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 91777.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 62172, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 61579.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 59211.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 62172, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 76974.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 60987.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 59211.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 59211.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 59211.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 59211.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 83614.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 106639, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 79514.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 59211.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 71053.7, "methodology": "case rate" }]}]} , { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 36053.6,"maximum": 64695.3,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 55443.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 37856.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 46869.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 37135.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 43264.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 64695.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 36053.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 36053.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 36053.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 50951.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 37495.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 55883, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 36053.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 51940.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 36053.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 37856.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 54980.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 36053.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 51940.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 36053.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 48239.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 36053.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 36053.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 47022.8, "methodology": "case rate" }]}]} , { "description": "Amputation of finger/thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 4154,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 578.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 526, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 526, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 526, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" }]}]} , { "description": "DRAINAGE OF PELVIS LESION", "code_information": [ { "code": "26990", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 4154,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "Drainage of pelvis bursa", "code_information": [ { "code": "26991", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 2062,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" }]}]} , { "description": "DRAINAGE OF BONE LESION", "code_information": [ { "code": "26992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1500,"minimum": 18.16,"maximum": 1500,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1500, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 825, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1500, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1500, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1200, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 860, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 450, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1200, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 786.83, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 946, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 860, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 860, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "270", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15296.9,"maximum": 78670.2,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 43769.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 43769.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 58660, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 52523.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 43769.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 43769.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 63241.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 56900.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 63241.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 15296.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 66857.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 43769.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 45520.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 45957.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 43769.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 57253.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 78670.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 43769.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 61957.1, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 45082.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 45957.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 43769.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 67842.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 43769.4, "methodology": "case rate" }]}]} , { "description": "Incision of hip tendon", "code_information": [ { "code": "27001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 4154,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "Biopsy of soft tissues", "code_information": [ { "code": "27040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Injection for hip x-ray", "code_information": [ { "code": "27093", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069,"minimum": 18.16,"maximum": 1069,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 587.95, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 855.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 855.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1069, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 320.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "INJECTION FOR HIP XRAY", "code_information": [ { "code": "27095", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 847,"minimum": 18.16,"maximum": 847,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 847, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 677.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 677.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 847, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 465.85, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 254.1, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" }]}]} , { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "271", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 17372.5,"maximum": 53768.1,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 46531.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 31221.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 31521.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 30020.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 30020.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 42345.4, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 30921, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 30020.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 30020.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 30020.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 36024.4, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 53768.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 31521.4, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 30020.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 40091.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 30020.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 43787.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 39641.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 43787.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 39026.4, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 30020.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 45694.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 30020.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 17372.5, "methodology": "case rate" }]}]} , { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "272", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 21287.5,"maximum": 37951.3,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 32921.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 21287.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 32252.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 21287.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 21287.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 21287.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 21287.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 37951.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 21287.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 22351.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 21287.5, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 21926.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 28052.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 25545, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 22351.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 29888.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 32921.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 28298.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 27673.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 21287.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 21287.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 22139, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 29804.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 32995.6, "methodology": "case rate" }]}]} , { "description": "Treat tail bone fracture", "code_information": [ { "code": "27200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 46.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 51.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 46.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 46.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 49.29, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 46.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" }]}]} , { "description": "Treat hip socket fracture", "code_information": [ { "code": "27220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 285, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 302.1, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat thigh fracture", "code_information": [ { "code": "27230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 288.75, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 262.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 262.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 278.25, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 262.5, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 262.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT THIGH FRACTURE", "code_information": [ { "code": "27232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5223.69,"minimum": 18.16,"maximum": 4178.95,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4178.95, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2873.03, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2873.03, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1567.11, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4178.95, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2873.03, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat thigh fracture", "code_information": [ { "code": "27238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 243, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 243, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 267.3, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 243, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 243, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 257.58, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" }]}]} , { "description": "Treat thigh fracture", "code_information": [ { "code": "27246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 118.72, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 123.2, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "Treat hip dislocation", "code_information": [ { "code": "27250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 204.65, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 204.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 225.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 216.93, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 204.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 204.65, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" }]}]} , { "description": "TREAT HIP DISLOCATION", "code_information": [ { "code": "27252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 5474.4,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 281.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3763.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2052.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 298.39, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "Treat hip dislocation", "code_information": [ { "code": "27256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 232.99, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 219.8, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT HIP DISLOCATION", "code_information": [ { "code": "27257", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 237, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 251.22, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" }]}]} , { "description": "Treat hip dislocation", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1039.38, "discounted_cash": 302,"minimum": 18.16,"maximum": 1039.38,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 260.7, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 237, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 237, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 571.66, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 311.81, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 831.5, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 251.22, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1039.38, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 237, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 831.5, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 237, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1039.38, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" }]}]} , { "description": "TREAT HIP DISLOCATION", "code_information": [ { "code": "27266", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 251.22, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 237, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [ { "code": "273", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20538.1,"maximum": 60625.6,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 34820.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 43948.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 20538.1, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 33806.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 33806.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 45205.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 33806.6, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 35496.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 45756.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 45756.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 33806.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 33806.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 51522.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 33806.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 35496.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 33806.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 33806.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 60625.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 35158.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 47746, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 41424.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 33806.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 52400.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 40567.9, "methodology": "case rate" }]}]} , { "description": "DRAIN THIGH/KNEE LESION", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" }]}]} , { "description": "Exploration of knee joint", "code_information": [ { "code": "27310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7533, "discounted_cash": 4154,"minimum": 18.16,"maximum": 7533,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 984.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 895, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 895, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4143.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 895, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2259.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "BIOPSY THIGH SOFT TISSUES", "code_information": [ { "code": "27323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" }]}]} , { "description": "Biopsy thigh soft tissues", "code_information": [ { "code": "27324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" }]}]} , { "description": "Partial removal leg bone(s)", "code_information": [ { "code": "27360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 4154,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3217.46, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 4060.59, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" }]}]} , { "description": "NJX CNTRST KNE ARTHG/CT/MRI", "code_information": [ { "code": "27369", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500,"minimum": 18.16,"maximum": 500,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 275, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 500, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC", "code_information": [ { "code": "274", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 28170.2,"maximum": 50417.1,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 36621.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 28170.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 50417.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 28170.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 28170.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 33851, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 37391, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 43663.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 28170.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 28170.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 37593.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 29578.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 39706.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 28170.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 28170.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 29297, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 33804.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 29578.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 29015.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 42846.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 37391, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 28170.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 50258.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 28170.2, "methodology": "case rate" }]}]} , { "description": "TOTAL KNEE ARTHROPLASTY", "code_information": [ { "code": "27447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10761, "discounted_cash": 16892,"minimum": 18.16,"maximum": 10761,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 10395.4, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 10761, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8608.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 10761, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8608.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10761, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10761, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3228.3, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 60767,"maximum": 109456,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 60767, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 93020.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 62590, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 60767, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 60767, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 60767, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 63197.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 63805.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 109456, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 60767, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 60767, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 81615.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 63805.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 60767, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 86202.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 94188.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 72920.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 60767, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 78997.1, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 60767, "methodology": "case rate" }]}]} , { "description": "Treatment of thigh fracture", "code_information": [ { "code": "27500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 247.51, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 233.5, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "TREATMENT OF THIGH FRACTURE", "code_information": [ { "code": "27501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "Treatment of thigh fracture", "code_information": [ { "code": "27502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326, "discounted_cash": 2062,"minimum": 18.16,"maximum": 326,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 97.8, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 326, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 326, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 326, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 260.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 179.3, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 260.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 326, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 326, "methodology": "fee schedule" }]}]} , { "description": "TREATMENT OF THIGH FRACTURE", "code_information": [ { "code": "27503", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1862.5, "discounted_cash": 2062,"minimum": 18.16,"maximum": 1862.5,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1862.5, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1490, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 558.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1862.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1862.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1024.38, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1862.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1862.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1862.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1490, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1862.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1862.5, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1862.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" }]}]} , { "description": "Treatment of thigh fracture", "code_information": [ { "code": "27508", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 244.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 259.17, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "Treatment of thigh fracture", "code_information": [ { "code": "27510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2834.19, "discounted_cash": 2062,"minimum": 18.16,"maximum": 2834.19,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 336.02, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2267.35, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 2834.19, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1558.8, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2267.35, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2834.19, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 317, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 850.26, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2834.19, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" }]}]} , { "description": "Treat thigh fx growth plate", "code_information": [ { "code": "27516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 244.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 259.17, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 244.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 244.5, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 268.95, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 244.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT THIGH FX GROWTH PLATE", "code_information": [ { "code": "27517", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 317, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 336.02, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" }]}]} , { "description": "TREAT KNEECAP FRACTURE", "code_information": [ { "code": "27520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 131, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 131, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 131, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 131, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 144.1, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 138.86, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT KNEE FRACTURE", "code_information": [ { "code": "27530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 128.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 136.21, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" }]}]} , { "description": "Treat knee fracture", "code_information": [ { "code": "27532", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3381, "discounted_cash": 4154,"minimum": 18.16,"maximum": 3381,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2704.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1014.3, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 3381, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3381, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 3381, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 227.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3381, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1859.55, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3381, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3381, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2704.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 241.15, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3381, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3381, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" }]}]} , { "description": "TREAT KNEE FRACTURE(S)", "code_information": [ { "code": "27538", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 118.72, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "TREAT KNEE DISLOCATION", "code_information": [ { "code": "27550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 172.7, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 157, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 157, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 166.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 157, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 157, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "Treat knee dislocation", "code_information": [ { "code": "27552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 166.42, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 157, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" }]}]} , { "description": "Treat kneecap dislocation", "code_information": [ { "code": "27560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 112.2, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 102, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 108.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 102, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 102, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 102, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "TREAT KNEECAP DISLOCATION", "code_information": [ { "code": "27562", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 134.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 142.57, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" }]}]} , { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 53675.6,"maximum": 96612.1,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 53675.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 53675.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 53675.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 55285.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 72038.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 64410.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 53675.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 53675.6, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 53675.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 96612.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 83197.1, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 53675.6, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 56359.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 53675.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 56359.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 53675.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 76087.4, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 82105.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 69778.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 55822.6, "methodology": "case rate" }]}]} , { "description": "DRAIN LOWER LEG LESION", "code_information": [ { "code": "27603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" }]}]} , { "description": "Drain lower leg bursa", "code_information": [ { "code": "27604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 4154,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" }]}]} , { "description": "INCISION OF ACHILLES TENDON", "code_information": [ { "code": "27605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6993, "discounted_cash": 2062,"minimum": 18.16,"maximum": 5594.4,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2097.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 965.8, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 878, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3846.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 878, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 878, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" }]}]} , { "description": "Biopsy lower leg soft tissue", "code_information": [ { "code": "27613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "BIOPSY LOWER LEG SOFT TISSUE", "code_information": [ { "code": "27614", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3647,"minimum": 18.16,"maximum": 8595.64,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5909.5, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 2889.62, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4208.19, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2945.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8595.64, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6661.32, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 2917.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3366.55, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3223.36, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3086.01, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5723.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4348.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2244.37, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 5610.92, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3927.64, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 2805.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" }]}]} , { "description": "Remove/graft leg bone lesion", "code_information": [ { "code": "27638", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7533, "discounted_cash": 9182,"minimum": 18.16,"maximum": 7533,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 740.3, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 673, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 673, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2259.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4143.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 673, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" }]}]} , { "description": "PARTIAL REMOVAL OF TIBIA", "code_information": [ { "code": "27640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 4154,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "Injection for ankle x-ray", "code_information": [ { "code": "27648", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069,"minimum": 18.16,"maximum": 1069,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1069, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 855.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 27.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 25, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 855.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 320.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 25, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 25, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 26.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 587.95, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "REPAIR ACHILLES TENDON", "code_information": [ { "code": "27650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9493, "discounted_cash": 9182,"minimum": 18.16,"maximum": 9493,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 4060.59, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2847.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9493, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3217.46, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9493, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9493, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9493, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9493, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 9493, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5221.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" }]}]} , { "description": "REPAIR OF LEG TENDON EACH", "code_information": [ { "code": "27658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10743, "discounted_cash": 4154,"minimum": 18.16,"maximum": 8594.4,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3222.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5908.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" }]}]} , { "description": "REPAIR OF ANKLE LIGAMENT", "code_information": [ { "code": "27695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10368, "discounted_cash": 9182,"minimum": 18.16,"maximum": 10368,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10368, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10368, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10368, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 10368, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8294.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3110.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8294.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10368, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5702.4, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" }]}]} , { "description": "REPAIR OF ANKLE LIGAMENT", "code_information": [ { "code": "27698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9243, "discounted_cash": 9182,"minimum": 18.16,"maximum": 9243,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9243, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7394.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5083.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2772.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9243, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9243, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7394.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9243, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9243, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 9243, "methodology": "fee schedule" }]}]} , { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 41411.6,"maximum": 74399.8,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 41411.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 41411.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 55475.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 58594, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 42654, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 43068.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 43482.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 43482.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 41411.6, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 53835.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 41411.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 49694, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 74399.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 41411.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 41411.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 63228.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 41411.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 41411.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 64188, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 41411.6, "methodology": "case rate" }]}]} , { "description": "TREATMENT OF TIBIA FRACTURE", "code_information": [ { "code": "27750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 142.5, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 156.75, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 142.5, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 142.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 142.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 151.05, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "Treatment of tibia fracture", "code_information": [ { "code": "27752", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5935.94, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4748.75,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 247.51, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1780.78, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3264.77, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 233.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4748.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4748.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Cltx medial ankle fx", "code_information": [ { "code": "27760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" }]}]} , { "description": "CLTX MED ANKLE FX W/MNPJ", "code_information": [ { "code": "27762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5598, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4478.4,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4478.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4478.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1679.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3078.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" }]}]} , { "description": "CLTX POST ANKLE FX", "code_information": [ { "code": "27767", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 469, "discounted_cash": 302,"minimum": 18.16,"maximum": 469,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 469, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 469, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 469, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 469, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 375.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 140.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 257.95, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 469, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 375.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Cltx post ankle fx w/mnpj", "code_information": [ { "code": "27768", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" }]}]} , { "description": "Treatment of fibula fracture", "code_information": [ { "code": "27780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "TREATMENT OF FIBULA FRACTURE", "code_information": [ { "code": "27781", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10053, "discounted_cash": 2062,"minimum": 18.16,"maximum": 8042.4,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 208.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 197, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8042.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8042.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3015.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5529.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" }]}]} , { "description": "TREATMENT OF ANKLE FRACTURE", "code_information": [ { "code": "27786", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 118.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 125.61, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1032.5, "discounted_cash": 302,"minimum": 18.16,"maximum": 1032.5,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 826, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1032.5, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 309.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1032.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 826, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 159, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 168.54, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 567.88, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" }]}]} , { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC", "code_information": [ { "code": "278", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 38645.8,"maximum": 69390.4,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 54648.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 38645.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 38645.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 38645.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 38645.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 38645.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 39805.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 50239.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 51740.6, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 40578.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 58970.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 40191.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 38645.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 38645.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 46375, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 69390.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 59901, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 38645.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 38645.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 40578.1, "methodology": "case rate" }]}]} , { "description": "TREATMENT OF ANKLE FRACTURE", "code_information": [ { "code": "27808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" }]}]} , { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 987.5, "discounted_cash": 2062,"minimum": 18.16,"maximum": 987.5,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 543.13, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 987.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 790, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 790, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 987.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 987.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 987.5, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 296.25, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "TREATMENT OF ANKLE FRACTURE", "code_information": [ { "code": "27814", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11433, "discounted_cash": 9182,"minimum": 18.16,"maximum": 11433,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3429.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9146.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6288.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10948.2, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11433, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11433, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10595, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11433, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9146.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" }]}]} , { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" }]}]} , { "description": "TREATMENT OF ANKLE FRACTURE", "code_information": [ { "code": "27818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2834.19, "discounted_cash": 2062,"minimum": 18.16,"maximum": 2834.19,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1558.8, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2834.19, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2267.35, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2834.19, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 2834.19, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 253.34, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 850.26, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 239, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2267.35, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" }]}]} , { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18993, "discounted_cash": 9182,"minimum": 18.16,"maximum": 16771.3,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14409.2, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10948.2, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10595, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14126.7, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5697.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 15194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 10446.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16771.3, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" }]}]} , { "description": "Treat lower leg fracture", "code_information": [ { "code": "27824", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT LOWER LEG FRACTURE", "code_information": [ { "code": "27825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9948.63, "discounted_cash": 2062,"minimum": 18.16,"maximum": 7958.9,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5471.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7958.9, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7958.9, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2984.59, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" }]}]} , { "description": "TREAT LOWER LEG JOINT", "code_information": [ { "code": "27829", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34887, "discounted_cash": 9182,"minimum": 18.16,"maximum": 27909.6,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14126.7, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 27909.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10466.1, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10595, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14409.2, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16771.3, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 27909.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 19187.8, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10948.2, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" }]}]} , { "description": "Treat lower leg dislocation", "code_information": [ { "code": "27830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 118.72, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 123.2, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT ANKLE DISLOCATION", "code_information": [ { "code": "27840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 89.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 89.5, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 89.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 94.87, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 98.45, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 89.5, "methodology": "fee schedule" }]}]} , { "description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [ { "code": "27884", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8493, "discounted_cash": 4154,"minimum": 18.16,"maximum": 7588.12,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2547.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6794.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6794.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4671.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "Amputation follow-up surgery", "code_information": [ { "code": "27886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8913,"minimum": 18.16,"maximum": 7130.4,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4902.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7130.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7130.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2673.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" }]}]} , { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC", "code_information": [ { "code": "279", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 27824.9,"maximum": 49791.7,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 39213.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 27824.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 27824.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 43128.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 27824.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 27824.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 29216.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 27824.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 37127, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 33389.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 27824.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 28937.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 29216.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 27824.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 28659.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 27824.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 36172.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 27824.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 49791.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 42315.1, "methodology": "case rate" }]}]} , { "description": "HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS ", "code_information": [ { "code": "2791", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5154.6,"maximum": 3.63031e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.45744e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.63031e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.45744e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.45744e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.63031e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5154.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.45744e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.45744e+007, "methodology": "case rate" }]}]} , { "description": "HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS ", "code_information": [ { "code": "2792", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6523.05,"maximum": 4.70105e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.70105e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.47719e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6523.05, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.47719e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.70105e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.47719e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.47719e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.47719e+007, "methodology": "case rate" }]}]} , { "description": "HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS ", "code_information": [ { "code": "2793", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10815.9,"maximum": 7.55949e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.19952e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.19952e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.55949e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.19952e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10815.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.19952e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.19952e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.55949e+007, "methodology": "case rate" }]}]} , { "description": "HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS ", "code_information": [ { "code": "2794", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 27276.8,"maximum": 1.68019e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.68019e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.60018e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 27276.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.60018e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.60018e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.60018e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.60018e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.68019e+008, "methodology": "case rate" }]}]} , { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7619.82,"maximum": 24681.2,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13960.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13960.8, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13960.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13960.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 16752.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14658.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13960.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 20975.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 24681.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 18149, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7619.82, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14519.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 20998, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13960.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 19010, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13960.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13960.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 14658.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 20998, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 18403.4, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 14379.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 21639.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 19437.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13960.8, "methodology": "case rate" }]}]} , { "description": "DRAINAGE OF BURSA OF FOOT", "code_information": [ { "code": "28001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2080,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" }]}]} , { "description": "Treatment of foot infection", "code_information": [ { "code": "28002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 2062,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" }]}]} , { "description": "TREATMENT OF FOOT INFECTION", "code_information": [ { "code": "28003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 4154,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" }]}]} , { "description": "ALCOHOLIC LIVER DISEASE ", "code_information": [ { "code": "2801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5267.86,"maximum": 3.77944e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.77944e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.59946e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5267.86, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.59946e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.59946e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.77944e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.59946e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.59946e+007, "methodology": "case rate" }]}]} , { "description": "Incision of toe tendon", "code_information": [ { "code": "28010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4946.48,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1854.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3400.7, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4946.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" }]}]} , { "description": "ALCOHOLIC LIVER DISEASE ", "code_information": [ { "code": "2802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6600.7,"maximum": 4.95126e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.95126e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6600.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.71549e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.71549e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.71549e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.71549e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.95126e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.71549e+007, "methodology": "case rate" }]}]} , { "description": "ALCOHOLIC LIVER DISEASE ", "code_information": [ { "code": "2803", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10517.5,"maximum": 7.85838e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.48417e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.48417e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10517.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.85838e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.48417e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.48417e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.48417e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.85838e+007, "methodology": "case rate" }]}]} , { "description": "DECOMPRESSION OF TIBIA NERVE", "code_information": [ { "code": "28035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8013, "discounted_cash": 2478,"minimum": 18.16,"maximum": 6410.4,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1982.54, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1906.29, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1906.29, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1963.48, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1906.29, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3888.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1525.03, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1906.29, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2859.43, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 2287.55, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2403.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1906.29, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6410.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2668.81, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 2001.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4407.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1906.29, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1906.29, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1906.29, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3812.58, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6410.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 2096.92, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1906.29, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4526.32, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1906.29, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2954.75, "methodology": "fee schedule" }]}]} , { "description": "ALCOHOLIC LIVER DISEASE ", "code_information": [ { "code": "2804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23733.2,"maximum": 1.73135e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.73135e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.64891e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.64891e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.64891e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 23733.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.73135e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.64891e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.64891e+008, "methodology": "case rate" }]}]} , { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7443.72,"maximum": 14203.5,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8175.79, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7443.72, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 12591.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8175.79, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8502.82, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8175.79, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8584.58, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8175.79, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8175.79, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 12672.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10628.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10590.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11186.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12070.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8175.79, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9810.95, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8175.79, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8421.06, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8584.58, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8175.79, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 12591.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 11399.7, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8175.79, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14203.5, "methodology": "case rate" }]}]} , { "description": "Remove/graft foot lesion", "code_information": [ { "code": "28102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7533, "discounted_cash": 9182,"minimum": 18.16,"maximum": 7533,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6026.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4143.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2259.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7533, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 7533, "methodology": "fee schedule" }]}]} , { "description": "Removal of foot lesion", "code_information": [ { "code": "28104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6993, "discounted_cash": 4154,"minimum": 18.16,"maximum": 6993,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1003.2, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2097.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 912, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 912, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6993, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3846.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 912, "methodology": "fee schedule" }]}]} , { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS ", "code_information": [ { "code": "2811", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7761.97,"maximum": 5.28884e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 5.03699e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.28884e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 7761.97, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 5.03699e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 5.03699e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5.03699e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 5.03699e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.28884e+007, "methodology": "case rate" }]}]} , { "description": "REVISION OF FOOT", "code_information": [ { "code": "28116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22062.2, "discounted_cash": 4154,"minimum": 18.16,"maximum": 17649.7,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 12134.2, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 17649.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6618.65, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 17649.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Removal of heel bone", "code_information": [ { "code": "28118", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6993, "discounted_cash": 4154,"minimum": 18.16,"maximum": 6993,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 832, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 915.2, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6993, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 832, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2097.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 832, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3846.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "REMOVAL OF HEEL SPUR", "code_information": [ { "code": "28119", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6993, "discounted_cash": 4154,"minimum": 18.16,"maximum": 6993,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6993, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 915.2, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 832, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 832, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2097.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 832, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3846.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS ", "code_information": [ { "code": "2812", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9207.37,"maximum": 6.66471e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.34734e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.34734e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9207.37, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.34734e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.66471e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.34734e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.34734e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.66471e+007, "methodology": "case rate" }]}]} , { "description": "Part removal of ankle/heel", "code_information": [ { "code": "28120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6993, "discounted_cash": 4154,"minimum": 18.16,"maximum": 6993,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1011, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2097.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1011, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1011, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1112.1, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6993, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5594.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 5129.16, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 4064.16, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3846.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "Partial removal of toe", "code_information": [ { "code": "28124", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6918, "discounted_cash": 4154,"minimum": 18.16,"maximum": 6918,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5534.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3804.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2075.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5534.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6918, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS ", "code_information": [ { "code": "2813", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12741.2,"maximum": 8.85363e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.43203e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12741.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.43203e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.85363e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.85363e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.43203e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.43203e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.43203e+007, "methodology": "case rate" }]}]} , { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS ", "code_information": [ { "code": "2814", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20766,"maximum": 1.36701e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.30192e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.30192e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.30192e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.36701e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.30192e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20766, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.30192e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.36701e+008, "methodology": "case rate" }]}]} , { "description": "Removal of foot foreign body", "code_information": [ { "code": "28190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4147, "discounted_cash": 903,"minimum": 18.16,"maximum": 3425,"payers_information":[{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 555.72, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1417.09, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 854.7, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 715.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 777, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 3317.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 972.51, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 722.44, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 833.58, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1244.1, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 764.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1389.3, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 729.38, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3317.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 1041.97, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 2280.85, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1649.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 777, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 694.65, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 1076.71, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 777, "methodology": "fee schedule" }]}]} , { "description": "REMOVAL OF FOOT FOREIGN BODY", "code_information": [ { "code": "28192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9243, "discounted_cash": 2080,"minimum": 18.16,"maximum": 7394.4,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 720, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 792, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 720, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2772.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2900, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5083.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 870, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7394.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 1595, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2900, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 720, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 720, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 2900, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3201.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3800.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2481.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 720, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1680.77, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1920.88, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2320, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2401.09, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7394.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2900, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 2320, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 720, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1664.76, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 792, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1760.8, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3265.49, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1600.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1648.75, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2241.02, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1280.58, "methodology": "fee schedule" }]}]} , { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6501.71,"maximum": 11171.5,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10077.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8809.35, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6761.78, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8199.05, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6501.71, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6501.71, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9494, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6696.76, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6826.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11171.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9730.59, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6501.71, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 8798.16, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9730.59, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7802.05, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6501.71, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8329.96, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6501.71, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8452.22, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6501.71, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6501.71, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6826.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6501.71, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6501.71, "methodology": "case rate" }]}]} , { "description": "REPAIR OF FOOT TENDON", "code_information": [ { "code": "28200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10593, "discounted_cash": 4154,"minimum": 18.16,"maximum": 8474.4,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5826.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8474.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3177.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "REPAIR OF FOOT TENDON", "code_information": [ { "code": "28208", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 4154,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" }]}]} , { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY ", "code_information": [ { "code": "2821", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5369.34,"maximum": 3.69395e+007,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.51805e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.51805e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.51805e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.51805e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.69395e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5369.34, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.69395e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.51805e+007, "methodology": "case rate" }]}]} , { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY ", "code_information": [ { "code": "2822", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6938.7,"maximum": 4.88138e+007,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.64894e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.64894e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6938.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.88138e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.64894e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.64894e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.88138e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.64894e+007, "methodology": "case rate" }]}]} , { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY ", "code_information": [ { "code": "2823", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11590.8,"maximum": 8.01375e+007,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11590.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.01375e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.63214e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.63214e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.63214e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.63214e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.01375e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.63214e+007, "methodology": "case rate" }]}]} , { "description": "Incision of toe tendon", "code_information": [ { "code": "28232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" }]}]} , { "description": "INCISION OF FOOT TENDON", "code_information": [ { "code": "28234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" }]}]} , { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY ", "code_information": [ { "code": "2824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 32255.5,"maximum": 1.84042e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.75278e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.75278e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.75278e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.75278e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 32255.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.84042e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.84042e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.75278e+008, "methodology": "case rate" }]}]} , { "description": "Repair of hammertoe", "code_information": [ { "code": "28285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8323, "discounted_cash": 4154,"minimum": 18.16,"maximum": 7588.12,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6658.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 947, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6658.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 947, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1041.7, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4577.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2496.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 947, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" }]}]} , { "description": "Partial removal of foot bone", "code_information": [ { "code": "28288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8493, "discounted_cash": 4154,"minimum": 18.16,"maximum": 7588.12,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4671.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2547.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6794.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6794.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "REPAIR HALLUX RIGIDUS", "code_information": [ { "code": "28289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8993, "discounted_cash": 4154,"minimum": 18.16,"maximum": 7588.12,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2697.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4946.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "COR HLX VLGS RSC PRX PHLX BS", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9993, "discounted_cash": 4154,"minimum": 18.16,"maximum": 7994.4,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1236, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5496.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1359.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7994.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7994.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1236, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2997.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1236, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "COR HLX VLGS DSTL MTAR OSTEO", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10713, "discounted_cash": 4154,"minimum": 18.16,"maximum": 8570.4,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3213.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8570.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1085, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1085, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8570.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1085, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5892.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1193.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" }]}]} , { "description": "Cor hlx vlgs double osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11118, "discounted_cash": 9182,"minimum": 18.16,"maximum": 11118,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6114.9, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1085, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11118, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10595, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3335.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10948.2, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8894.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1193.5, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8894.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1085, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11118, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11118, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1085, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" }]}]} , { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12036.4,"maximum": 30669.1,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 26763.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 17266.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 24153.6, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 22446.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 17784.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 18130.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 17266.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 17266.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 12036.4, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 18130.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 17266.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 26063.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 17266.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 17957.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 20668, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 17266.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 17266.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 30669.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 20720.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 22868.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 22829.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 22829.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 17266.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 17266.8, "methodology": "case rate" }]}]} , { "description": "OTHER DISORDERS OF THE LIVER ", "code_information": [ { "code": "2831", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5752.95,"maximum": 3.81438e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.63274e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 5752.95, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.63274e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.81438e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.63274e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.63274e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.63274e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.81438e+007, "methodology": "case rate" }]}]} , { "description": "OTHER DISORDERS OF THE LIVER ", "code_information": [ { "code": "2832", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6813.45,"maximum": 4.84269e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.61209e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.84269e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.61209e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.61209e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6813.45, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.61209e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.61209e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.84269e+007, "methodology": "case rate" }]}]} , { "description": "OTHER DISORDERS OF THE LIVER ", "code_information": [ { "code": "2833", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10269.9,"maximum": 7.37043e+007,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.37043e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.01946e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10269.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.37043e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.01946e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.01946e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.01946e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.01946e+007, "methodology": "case rate" }]}]} , { "description": "OTHER DISORDERS OF THE LIVER ", "code_information": [ { "code": "2834", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20991.9,"maximum": 1.4797e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20991.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.4797e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.40924e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.40924e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.40924e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.40924e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.40924e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.4797e+008, "methodology": "case rate" }]}]} , { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6687.25,"maximum": 11507.5,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10365.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7021.61, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6687.25, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9779.57, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9948.96, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9062.8, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6887.87, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6687.25, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8938.79, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6687.25, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6687.25, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6687.25, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11507.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6687.25, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8024.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8693.42, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6954.74, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9948.96, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 9007.05, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8580.52, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6687.25, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6687.25, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6687.25, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7021.61, "methodology": "case rate" }]}]} , { "description": "Treatment of heel fracture", "code_information": [ { "code": "28400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1360, "discounted_cash": 302,"minimum": 18.16,"maximum": 1360,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 140, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 148.4, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 140, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 154, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 140, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1088, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 140, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 748, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1360, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 408, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1088, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "TREATMENT OF HEEL FRACTURE", "code_information": [ { "code": "28405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 999.15, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 999.15, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 229.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 999.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 216.5, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 999.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" }]}]} , { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT ", "code_information": [ { "code": "2841", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6203.76,"maximum": 4.97498e+007,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.73807e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.73807e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.73807e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 4.97498e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 6203.76, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 4.97498e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.73807e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.73807e+007, "methodology": "case rate" }]}]} , { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT ", "code_information": [ { "code": "2842", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8274.93,"maximum": 6.30842e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.00802e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.00802e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.00802e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.00802e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.30842e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.30842e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 8274.93, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.00802e+007, "methodology": "case rate" }]}]} , { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT ", "code_information": [ { "code": "2843", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 11924.7,"maximum": 9.01087e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.58178e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.58178e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.01087e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.58178e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.01087e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 11924.7, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.58178e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.58178e+007, "methodology": "case rate" }]}]} , { "description": "TREATMENT OF ANKLE FRACTURE", "code_information": [ { "code": "28430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 959.2, "discounted_cash": 302,"minimum": 18.16,"maximum": 959.2,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 527.56, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 111, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 111, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 111, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 287.76, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 767.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 767.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 122.1, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 959.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 117.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 111, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "Treatment of ankle fracture", "code_information": [ { "code": "28435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 145, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 153.7, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" }]}]} , { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT ", "code_information": [ { "code": "2844", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23609.7,"maximum": 1.60924e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.53261e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.60924e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.53261e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.53261e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.53261e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.60924e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 23609.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.53261e+008, "methodology": "case rate" }]}]} , { "description": "Treat midfoot fracture each", "code_information": [ { "code": "28450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 639.75, "discounted_cash": 302,"minimum": 18.16,"maximum": 639.75,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 511.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 114, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 639.75, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 511.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 351.86, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 639.75, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 191.93, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 639.75, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 639.75, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 639.75, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 120.84, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [ { "code": "28455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 2062,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 127, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 134.62, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 127, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 127, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 139.7, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 127, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" }]}]} , { "description": "Treat metatarsal fracture", "code_information": [ { "code": "28470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 333, "discounted_cash": 302,"minimum": 18.16,"maximum": 333,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 266.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 333, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 333, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 183.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 89.57, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 84.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 266.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 333, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 99.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 333, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "TREAT METATARSAL FRACTURE", "code_information": [ { "code": "28475", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 125.08, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 118, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "Treat metatarsal fracture", "code_information": [ { "code": "28476", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7233, "discounted_cash": 4154,"minimum": 18.16,"maximum": 7233,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1862.74, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5786.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3978.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2350.86, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2169.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7233, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5786.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "TREAT METATARSAL FRACTURE", "code_information": [ { "code": "28485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9228, "discounted_cash": 9182,"minimum": 18.16,"maximum": 9228,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2768.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 9228, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9228, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 848, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9228, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9228, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7382.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9228, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9228, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5075.4, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 932.8, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 848, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7382.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 848, "methodology": "fee schedule" }]}]} , { "description": "Treat big toe fracture", "code_information": [ { "code": "28490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253, "discounted_cash": 302,"minimum": 18.16,"maximum": 253,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 60.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 55, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 253, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 253, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 55, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 58.3, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 253, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 202.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 253, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 253, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 253, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 55, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 253, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 139.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 253, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 253, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 253, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 75.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 253, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 202.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT BIG TOE FRACTURE", "code_information": [ { "code": "28495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 80.03, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 75.5, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4531.32,"maximum": 8105.33,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4531.32, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4531.32, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6461.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 4531.32, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5987.55, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 4757.89, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 4531.32, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 4531.32, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 5437.58, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 4531.32, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 4531.32, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 4757.89, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 4712.57, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 7602.71, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 7837.17, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 7095.19, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8105.33, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 7023.55, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 7837.17, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 4667.26, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5890.72, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 4531.32, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 5668.92, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 4531.32, "methodology": "case rate" }]}]} , { "description": "Treatment of toe fracture", "code_information": [ { "code": "28510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 551.25, "discounted_cash": 302,"minimum": 18.16,"maximum": 551.25,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 551.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 165.38, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 441, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 551.25, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 303.19, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 551.25, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 441, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 551.25, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 551.25, "methodology": "fee schedule" }]}]} , { "description": "TREATMENT OF TOE FRACTURE", "code_information": [ { "code": "28515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 70.49, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 66.5, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" }]}]} , { "description": "TREAT SESAMOID BONE FRACTURE", "code_information": [ { "code": "28530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" }]}]} , { "description": "TREAT FOOT DISLOCATION", "code_information": [ { "code": "28540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 125.61, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 118.5, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat foot dislocation", "code_information": [ { "code": "28545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 4154,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 118.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 118.5, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 118.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 130.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 118.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 125.61, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "TREAT FOOT DISLOCATION", "code_information": [ { "code": "28570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 118.72, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 123.2, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" }]}]} , { "description": "Treat foot dislocation", "code_information": [ { "code": "28575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 4154,"minimum": 18.16,"maximum": 9753.36,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 112, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3657.51, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 118.72, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6705.44, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9753.36, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" }]}]} , { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7932.54,"maximum": 33534.7,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 18849, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 33534.7, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 18849, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 18849, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 27495.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 18849, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 18849, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 19791.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 18849, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 18849, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 19791.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 19602.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 19414.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 27495.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 24892.7, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 26410.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 29215.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 28499.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 18849, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 18849, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 22618.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7932.54, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 25005, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 24503.7, "methodology": "case rate" }]}]} , { "description": "TREAT FOOT DISLOCATION", "code_information": [ { "code": "28600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 54.5, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 54.5, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 59.95, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 54.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 57.77, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 54.5, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "Treat foot dislocation", "code_information": [ { "code": "28605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 302,"minimum": 18.16,"maximum": 999.15,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 73.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 999.15, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 299.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 77.91, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 549.53, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 799.32, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" }]}]} , { "description": "TREAT TOE DISLOCATION", "code_information": [ { "code": "28630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 302,"minimum": 18.16,"maximum": 949.69,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 522.33, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 949.69, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 54.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 54.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 57.77, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 54.5, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 59.95, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 54.5, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 759.75, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 284.91, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat toe dislocation", "code_information": [ { "code": "28635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 2062,"minimum": 18.16,"maximum": 4869.68,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 3173.64, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 1745.5, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3347.91, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 1650.29, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 2459.57, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3767.76, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1269.46, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 1666.16, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1282.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 1634.42, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1826.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4869.68, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 87.98, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3237.11, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2221.55, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 1904.18, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 2380.23, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1586.82, "methodology": "fee schedule" }]}]} , { "description": "TREAT TOE DISLOCATION", "code_information": [ { "code": "28660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 721.3, "discounted_cash": 302,"minimum": 18.16,"maximum": 721.3,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 396.71, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 53.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 48.5, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 577.04, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 51.41, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 48.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 721.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 48.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 577.04, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 48.5, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 216.39, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" }]}]} , { "description": "Treat toe dislocation", "code_information": [ { "code": "28665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1103.75, "discounted_cash": 344,"minimum": 18.16,"maximum": 1103.75,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 212.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 318.18, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 275.76, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 530.3, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 883, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 883, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 410.98, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 540.91, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 629.58, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1016.04, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 273.1, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 371.21, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 397.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1103.75, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 607.06, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1103.75, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 291.66, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 331.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 278.41, "methodology": "fee schedule" }]}]} , { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9623.97,"maximum": 16826.5,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9623.97, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 14917.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9623.97, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 16826.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9623.97, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11548.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9623.97, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9623.97, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 13251.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 14568.3, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 10008.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 10105.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9623.97, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9623.97, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 13189.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 12511.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9912.69, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 10105.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 10188.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9623.97, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 12546.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9623.97, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 14299.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 14568.3, "methodology": "case rate" }]}]} , { "description": "FUSION OF FOOT BONES", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11493, "discounted_cash": 16892,"minimum": 18.16,"maximum": 11493,"payers_information":[{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 10395.4, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3447.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6321.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 9194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 11493, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11493, "methodology": "fee schedule" }]}]} , { "description": "Fusion of big toe joint", "code_information": [ { "code": "28750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10983, "discounted_cash": 9182,"minimum": 18.16,"maximum": 10983,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3294.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 10983, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1053, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8786.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10983, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8786.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1158.3, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10595, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1053, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10983, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1053, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10948.2, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6040.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" }]}]} , { "description": "FUSION OF BIG TOE JOINT", "code_information": [ { "code": "28755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9948, "discounted_cash": 9182,"minimum": 18.16,"maximum": 9948,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5650.68, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 9948, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9948, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8476.02, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7345.88, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9948, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9888.69, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7275.25, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1045, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7958.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9948, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2984.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7769.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7958.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9948, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1045, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7063.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5471.4, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7416.52, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1149.5, "methodology": "fee schedule" }]}]} , { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7183.77,"maximum": 40339.3,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 22606, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 22606, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 22606, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 30658.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 34282.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 31769.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 35039.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 29387.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 22606, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 33864.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 22606, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 27127.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 23284.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 22606, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 30078.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 23736.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7183.77, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 22606, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 22606, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 23510.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 22606, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 40339.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 33864.8, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 23736.3, "methodology": "case rate" }]}]} , { "description": "UNLISTED PX FOOT/TOES", "code_information": [ { "code": "28899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7743, "discounted_cash": 302,"minimum": 18.16,"maximum": 6194.4,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2322.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4258.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" }]}]} , { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5897.15,"maximum": 22988.6,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13026.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 13547.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13026.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13026.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13026.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13026.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 15631.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13026.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 13417, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 19536.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 21653.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 13677.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13026.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 21653.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 16934.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13026.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 20190.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 18104.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13026.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 5897.15, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 17141.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 19603.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 13677.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 22988.6, "methodology": "case rate" }]}]} , { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6337.42,"maximum": 15949,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9654.02, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 12560.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 12986.4, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9654.02, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 11756.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 10136.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 11892.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9654.02, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13554.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9654.02, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11584.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6337.42, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 12550.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 14963.7, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9654.02, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9654.02, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 15949, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9654.02, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 10040.2, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 10136.7, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9943.64, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9654.02, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 12986.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9654.02, "methodology": "case rate" }]}]} , { "description": "APPLICATION OF FIGURE EIGHT", "code_information": [ { "code": "29049", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.38, "discounted_cash": 344,"minimum": 18.16,"maximum": 183.38,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 51.94, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 146.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 146.7, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 100.86, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 55.01, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 183.38, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 183.38, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 183.38, "methodology": "case rate" }]}]} , { "description": "Application of long arm cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 992, "discounted_cash": 344,"minimum": 18.16,"maximum": 992,"payers_information":[{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 793.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 629.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 992, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 42.5, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 410.98, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 273.1, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 397.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 793.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 530.3, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 318.18, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 45.05, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 291.66, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 212.12, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 371.21, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 540.91, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 545.6, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 297.6, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 275.76, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 278.41, "methodology": "fee schedule" }]}]} , { "description": "APPLICATION OF FOREARM CAST", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1103.75, "discounted_cash": 344,"minimum": 18.16,"maximum": 1103.75,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1103.75, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 45.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 48.23, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 331.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 540.91, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 278.41, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 318.18, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 883, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 275.76, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 397.73, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 629.58, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 273.1, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 410.98, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 883, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 607.06, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 212.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 291.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 530.3, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 371.21, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" }]}]} , { "description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [ { "code": "291", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6381.94,"maximum": 19973.6,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 11361.6, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 19973.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 17610.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 13633.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 11361.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 11361.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 14893.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 15508.7, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11929.7, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11816.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 11361.6, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11361.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 15730.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 11361.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11361.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6381.94, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 14770.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11929.7, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 17130.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16974.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 11361.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 11702.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 17130.5, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 11361.6, "methodology": "case rate" }]}]} , { "description": "Apply long arm splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.75, "discounted_cash": 202,"minimum": 18.16,"maximum": 671.75,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 671.75, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 163.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 317.36, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 233.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 369.46, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 186.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 33.5, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 124.46, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 217.8, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 311.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 369.46, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 671.75, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 241.13, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 35.51, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 537.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 671.75, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 369.46, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 671.75, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 161.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 537.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 369.39, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 201.53, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 171.13, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 160.24, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 671.75, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" }]}]} , { "description": "APPLY FOREARM SPLINT", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.75, "discounted_cash": 163,"minimum": 18.16,"maximum": 671.75,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 369.46, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 131.16, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 26, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 26, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 28.6, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 671.75, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 176.57, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 132.43, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 138.73, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 26, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 100.9, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 257.28, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 252.24, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 129.9, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 151.34, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 537.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 26, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 195.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 537.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 27.56, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 299.46, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 189.18, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 201.53, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Apply forearm splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500.1, "discounted_cash": 163,"minimum": 18.16,"maximum": 500.1,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 257.28, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 176.57, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 299.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 500.1, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 138.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 129.9, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 131.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 28.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 26, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 400.08, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 195.49, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150.03, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 275.06, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 26, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 132.43, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 27.56, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 100.9, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 26, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 400.08, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 151.34, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 189.18, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 252.24, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 500.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" }]}]} , { "description": "APPLICATION OF FINGER SPLINT", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405.5, "discounted_cash": 163,"minimum": 18.16,"maximum": 405.5,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 405.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 151.34, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 176.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 324.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 100.9, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 223.03, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 252.24, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 138.73, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 129.9, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 405.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 131.16, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 324.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 257.28, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 121.65, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 189.18, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 195.49, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 299.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 405.5, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 132.43, "methodology": "fee schedule" }]}]} , { "description": "Application of finger splint", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268, "discounted_cash": 78,"minimum": 18.16,"maximum": 268,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 147.4, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 143.39, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 27.71, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 29.37, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 84.55, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 214.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 214.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 268, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 268, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 268, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 80.4, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 48.31, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 90.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 72.47, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 27.71, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 63.41, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 93.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 27.71, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 62.2, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 30.48, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 123.2, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 62.81, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 66.43, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 27.71, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 120.78, "methodology": "fee schedule" }]}]} , { "description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [ { "code": "292", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5593.24,"maximum": 13324.6,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7690.48, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11323.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7690.48, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 13324.6, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9228.58, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7690.48, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 9935.4, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8075, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9997.62, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11920.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7690.48, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7690.48, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7690.48, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10727.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 5593.24, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7921.19, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10493.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7998.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8075, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7690.48, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7690.48, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7690.48, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11849.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11849.8, "methodology": "case rate" }]}]} , { "description": "STRAPPING OF CHEST", "code_information": [ { "code": "29200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 625.75, "discounted_cash": 202,"minimum": 18.16,"maximum": 625.75,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 171.13, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 160.24, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 34.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 500.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 186.68, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 36.92, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 38.31, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 34.83, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 500.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 187.72, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 34.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 317.36, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 625.75, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 233.35, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 34.83, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 217.8, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 163.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 124.46, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 161.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 241.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 311.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 326.74, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 369.39, "methodology": "fee schedule" }]}]} , { "description": "Strapping of shoulder", "code_information": [ { "code": "29240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 442.5, "discounted_cash": 163,"minimum": 18.16,"maximum": 442.5,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 252.24, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 20.67, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 100.9, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 19.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 189.18, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 129.9, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 354, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 19.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 354, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 131.16, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 326.74, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 132.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 21.45, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 257.28, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 19.5, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 19.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 442.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 195.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 176.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 138.73, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 151.34, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 299.46, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 132.43, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" }]}]} , { "description": "STRAPPING OF ELBOW OR WRIST", "code_information": [ { "code": "29260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515, "discounted_cash": 78,"minimum": 18.16,"maximum": 515,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 63.41, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 31.38, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 123.2, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 34.52, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 154.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 90.58, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 412, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 33.26, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 31.38, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 62.2, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 31.38, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 120.78, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 143.39, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 31.38, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 93.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 326.74, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 62.81, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 48.31, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 515, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 66.43, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 72.47, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 84.55, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 412, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "Strapping of hand or finger", "code_information": [ { "code": "29280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341, "discounted_cash": 78,"minimum": 18.16,"maximum": 341,"payers_information":[{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 63.41, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 48.31, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 341, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 62.2, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 120.78, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 93.6, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 326.74, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 123.2, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 272.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 66.43, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 143.39, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 102.3, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 72.47, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 62.81, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 90.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 84.55, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 272.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "HEART FAILURE AND SHOCK WITHOUT CC/MCC", "code_information": [ { "code": "293", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5156.62,"maximum": 8735.26,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 5156.62, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 5188.91, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 5156.62, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 6513.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 7872.52, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 5156.62, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 5156.62, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 6703.61, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 5156.62, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 8695.79, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7423.59, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 5156.62, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 5414.45, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 5156.62, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 5362.88, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 5156.62, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 5414.45, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 8695.79, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 8735.26, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 5156.62, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 7992.76, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 5311.32, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 6187.94, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6879.5, "methodology": "case rate" }]}]} , { "description": "APPLICATION OF LONG LEG CAST", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1103.75, "discounted_cash": 344,"minimum": 18.16,"maximum": 1103.75,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 607.06, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 273.1, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 397.73, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 629.58, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 371.21, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 278.41, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 331.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 540.91, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 212.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 883, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 883, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 530.3, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 291.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1103.75, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 318.18, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 275.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 410.98, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 265.15, "methodology": "fee schedule" }]}]} , { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6803.85,"maximum": 17014.7,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 14459.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9727.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 10019.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9727.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9727.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9727.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 13435.1, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 12646.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 10214.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 12686.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9727.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 13400, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6803.85, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9727.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9727.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 17014.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 10214.3, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9727.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11673.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 14840.1, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 15078.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 14840.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9727.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 10117, "methodology": "case rate" }]}]} , { "description": "APPLY SHORT LEG CAST", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 777.75, "discounted_cash": 344,"minimum": 18.16,"maximum": 777.75,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 397.73, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 629.58, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 530.3, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 53.53, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 622.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 278.41, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 273.1, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 540.91, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 371.21, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 275.76, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 212.12, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 410.98, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 318.18, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 233.32, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 622.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 777.75, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 777.75, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 427.76, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 291.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 50.5, "methodology": "fee schedule" }]}]} , { "description": "Apply short leg cast", "code_information": [ { "code": "29425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 693, "discounted_cash": 344,"minimum": 18.16,"maximum": 693,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 629.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 397.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 693, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 693, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 693, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 410.98, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 55.65, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 381.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 540.91, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 278.41, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 693, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 275.76, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 207.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 291.66, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 530.3, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 212.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 554.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 318.18, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 52.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 693, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 554.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 371.21, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 273.1, "methodology": "fee schedule" }]}]} , { "description": "APPLICAT OF RIGID TOTAL CONTACT LEG CAST", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 472.88, "discounted_cash": 344,"minimum": 18.16,"maximum": 472.88,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 291.66, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 371.21, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 472.88, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 410.98, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 318.18, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 101.47, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 141.86, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 107.56, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 472.88, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 111.62, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 397.73, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 472.88, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 275.76, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 101.47, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 472.88, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 101.47, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 212.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 378.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 472.88, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 378.3, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 101.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 260.08, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 278.41, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 273.1, "methodology": "fee schedule" }]}]} , { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6588.59,"maximum": 11129.4,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 7737.14, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7180.28, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8202.43, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 9824.25, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8616.34, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7180.28, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 11129.4, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9334.36, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7180.28, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7180.28, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7539.29, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7539.29, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 7325.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7180.28, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7467.49, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7180.28, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7395.69, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7180.28, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 8349.06, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 7277.59, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 7277.59, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7180.28, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 6588.59, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7180.28, "methodology": "case rate" }]}]} , { "description": "APPLICATION LONG LEG SPLINT", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.75, "discounted_cash": 202,"minimum": 18.16,"maximum": 671.75,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 317.36, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 186.68, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 124.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 369.39, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 163.35, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 201.53, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 241.13, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 217.8, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 40.7, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 537.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 160.24, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 233.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 369.46, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 311.14, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 39.22, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 171.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 671.75, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 37, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 37, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 537.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 37, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 37, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 161.79, "methodology": "fee schedule" }]}]} , { "description": "Application lower leg splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.75, "discounted_cash": 202,"minimum": 18.16,"maximum": 671.75,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 537.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 124.46, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 160.24, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 201.53, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 233.35, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 186.68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 369.39, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 161.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 163.35, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 37.1, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 35, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 35, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 35, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 537.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 38.5, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 241.13, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 311.14, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 171.13, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 369.46, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 671.75, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 317.36, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 217.8, "methodology": "fee schedule" }]}]} , { "description": "STRAPPING OF HIP", "code_information": [ { "code": "29520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.75, "discounted_cash": 163,"minimum": 18.16,"maximum": 272.75,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 151.34, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 32.99, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 272.75, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 138.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 176.57, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 252.24, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 195.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 257.28, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 131.16, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 100.9, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 32.99, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 272.75, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 189.18, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 218.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 132.43, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 218.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 32.99, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 36.29, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 272.75, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 129.9, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 81.83, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 272.75, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 34.97, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 32.99, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 272.75, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" }]}]} , { "description": "Strapping of knee", "code_information": [ { "code": "29530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 442.5, "discounted_cash": 163,"minimum": 18.16,"maximum": 442.5,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 326.74, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 132.75, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 257.28, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 195.49, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 25.5, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 299.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 252.24, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 28.05, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 27.03, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 132.43, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 129.9, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 189.18, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 442.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 176.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 25.5, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 100.9, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 151.34, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 25.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 354, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 138.73, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 354, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 25.5, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 131.16, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "STRAPPING OF ANKLE AND/OR FT", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 844, "discounted_cash": 202,"minimum": 18.16,"maximum": 844,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 241.13, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 22, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 160.24, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 675.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 161.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 171.13, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 311.14, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 253.2, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 21.2, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 675.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 186.68, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 317.36, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 369.39, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 233.35, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 217.8, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 163.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 326.74, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 124.46, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 844, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" }]}]} , { "description": "Strapping of toes", "code_information": [ { "code": "29550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 446.25, "discounted_cash": 78,"minimum": 18.16,"maximum": 446.25,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 22, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 357, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 143.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 84.55, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 446.25, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 66.43, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 123.2, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 62.2, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 120.78, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 72.47, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 21.2, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 133.88, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 63.41, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 62.81, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 90.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 93.6, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 20, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 326.74, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 48.31, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 60.39, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 357, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "APPLICATION OF PASTE BOOT", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 717, "discounted_cash": 202,"minimum": 18.16,"maximum": 717,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 233.35, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 311.14, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 124.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 317.36, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 163.35, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 186.68, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 326.74, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 573.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 241.13, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 160.24, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 369.39, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 171.13, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 215.1, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 329.92, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 161.79, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 573.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 217.8, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 717, "methodology": "case rate" }]}]} , { "description": "Apply multlay comprs lwr leg", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 348.1, "discounted_cash": 202,"minimum": 18.16,"maximum": 348.1,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 186.68, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 233.35, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 278.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 104.43, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 160.24, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 311.14, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 278.48, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 217.8, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 348.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 171.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 136, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 241.13, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 348.1, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 136, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 124.46, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 136, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 161.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 317.36, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 163.35, "methodology": "fee schedule" }]}]} , { "description": "APPL MULTLAY COMPRS ARM/HAND", "code_information": [ { "code": "29584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345, "discounted_cash": 202,"minimum": 18.16,"maximum": 345,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 217.8, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 171.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 161.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 276, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 311.14, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 189.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 345, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 103.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 345, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 233.35, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 124.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 186.68, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 163.35, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 241.13, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 189.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 189.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 276, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 160.24, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 317.36, "methodology": "fee schedule" }]}]} , { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14104.2,"maximum": 24941,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 19642.4, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14668.4, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14809.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 14104.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 15172.2, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 16925, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 18335.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 19489.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 21195.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 21861.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 14104.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 14104.2, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 14527.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 14104.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 14104.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 18597.1, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 24941, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 17644.1, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 14809.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 19489.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 14104.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 14104.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 14104.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 14104.2, "methodology": "case rate" }]}]} , { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6591.91,"maximum": 11334.8,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6591.91, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 9519.05, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 8532, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6591.91, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8569.48, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 7724.24, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8451.76, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 8926.81, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6921.51, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6789.67, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6591.91, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9632.82, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6855.59, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6591.91, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11334.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6591.91, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7910.29, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 8532, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10217.5, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6591.91, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6591.91, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6591.91, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6591.91, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6921.51, "methodology": "case rate" }]}]} , { "description": "Removal/revision of cast", "code_information": [ { "code": "29700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225, "discounted_cash": 344,"minimum": 18.16,"maximum": 225,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 123.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 180, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 225, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 212.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 180, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 67.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 225, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 123.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 123.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" }]}]} , { "description": "REMOVAL/REVISION OF CAST", "code_information": [ { "code": "29705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 209, "discounted_cash": 344,"minimum": 18.16,"maximum": 209,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 62.7, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 114.95, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 114.95, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 114.95, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 167.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 209, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 167.2, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 209, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 209, "methodology": "fee schedule" }]}]} , { "description": "Windowing of cast", "code_information": [ { "code": "29730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 625.75, "discounted_cash": 202,"minimum": 18.16,"maximum": 625.75,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 500.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 187.72, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 344.16, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 311.14, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 160.24, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 500.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 163.35, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 344.16, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 171.13, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 344.16, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 233.35, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 241.13, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 369.39, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 217.8, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 317.36, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 625.75, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 124.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 186.68, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 161.79, "methodology": "fee schedule" }]}]} , { "description": "WEDGING OF CAST", "code_information": [ { "code": "29740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1103.75, "discounted_cash": 344,"minimum": 18.16,"maximum": 1103.75,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1103.75, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 331.13, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 278.41, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 273.1, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 607.06, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 629.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 318.18, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 23.32, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 22, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 212.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 530.3, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 883, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 883, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 607.06, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 275.76, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 371.21, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 607.06, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 265.15, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 540.91, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 410.98, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 397.73, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 291.66, "methodology": "fee schedule" }]}]} , { "description": "UNLISTED PX CASTING/STRPG", "code_information": [ { "code": "29799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 625.75, "discounted_cash": 202,"minimum": 18.16,"maximum": 625.75,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 241.13, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 500.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 500.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 311.14, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 317.36, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 344.16, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 344.16, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 217.8, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 163.35, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 160.24, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 161.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 233.35, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 187.72, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 344.16, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 171.13, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 369.39, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 186.68, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 155.57, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 124.46, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 625.75, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 155.57, "methodology": "fee schedule" }]}]} , { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 4110.43,"maximum": 8636.68,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 4110.43, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 4110.43, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 4110.43, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 4110.43, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 4110.43, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 4315.95, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5377.4, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 4932.52, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 4315.95, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 6423.94, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 5815.76, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4110.43, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 6371.17, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6827.97, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6423.94, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 4110.43, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8636.68, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 4110.43, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 5091.24, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 4233.74, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 4274.85, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4110.43, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5802.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5343.56, "methodology": "case rate" }]}]} , { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29881", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7233, "discounted_cash": 4154,"minimum": 18.16,"maximum": 7233,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5786.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 4488.02, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1025.2, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3556.14, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 932, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 932, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 932, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5786.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2169.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 3978.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7233, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" }]}]} , { "description": "SCOPE PLANTAR FASCIOTOMY", "code_information": [ { "code": "29893", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7743, "discounted_cash": 4154,"minimum": 18.16,"maximum": 7588.12,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 6194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 4258.65, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6194.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2322.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" }]}]} , { "description": "Ankle arthroscopy/surgery", "code_information": [ { "code": "29894", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10533, "discounted_cash": 4154,"minimum": 18.16,"maximum": 8426.4,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8426.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5793.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 932, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 932, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8426.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 932, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3159.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1025.2, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "Ankle arthroscopy/surgery", "code_information": [ { "code": "29897", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9633, "discounted_cash": 4154,"minimum": 18.16,"maximum": 7706.4,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 4488.02, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 932, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5298.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7706.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 932, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7706.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 932, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1025.2, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2889.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3556.14, "methodology": "case rate" }]}]} , { "description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9633, "discounted_cash": 4154,"minimum": 18.16,"maximum": 7706.4,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5298.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6391.58, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 932, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3355.58, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4953.47, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3556.14, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2889.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3323.62, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1025.2, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 932, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 4488.02, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4474.11, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7706.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 932, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7588.12, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3515.37, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6519.41, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4793.69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7706.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3291.66, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2556.63, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3834.95, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3195.79, "methodology": "fee schedule" }]}]} , { "description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [ { "code": "299", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7669.49,"maximum": 24520.9,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13872.3, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 20838.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13872.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13872.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7669.49, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 21502, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 18433.3, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 18034, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14427.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 18283.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13872.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 16646.7, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14565.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13872.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13872.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13872.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 19311.6, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13872.3, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 14288.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 24520.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13872.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 14565.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 18433.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 16688.2, "methodology": "case rate" }]}]} , { "description": "UNLISTED PX ARTHROSCOPY", "code_information": [ { "code": "29999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9633, "discounted_cash": 302,"minimum": 18.16,"maximum": 7706.4,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 239.81, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 256.11, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 349.25, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 325.96, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 4488.02, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 465.66, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 279.4, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 552.83, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 5298.15, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7706.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 242.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 360.89, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 232.83, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 244.47, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2889.9, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 3556.14, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 7706.4, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 474.97, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 186.26, "methodology": "fee schedule" }]}]} , { "description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [ { "code": "300", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6684.28,"maximum": 16599.3,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9498.56, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 13072.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 13139, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 12348.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 14106.8, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9498.56, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 11895, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9498.56, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 13139, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9498.56, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9498.56, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 9973.49, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11398.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6684.28, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 9973.49, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 16599.3, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 14722.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 9878.5, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9498.56, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 9783.52, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9498.56, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9498.56, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9498.56, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 12377.2, "methodology": "case rate" }]}]} , { "description": "Drainage of nose lesion", "code_information": [ { "code": "30020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1051.14, "discounted_cash": 706,"minimum": 18.16,"maximum": 1051.14,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 841.99, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 840.91, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1051.14, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 1051.14, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 564.95, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 840.91, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 651.86, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 315.34, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 570.38, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1051.14, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 797, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 797, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 797, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 434.58, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 876.7, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1051.14, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 597.54, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1051.14, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 760.51, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 559.52, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 578.13, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1051.14, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 814.83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 543.22, "methodology": "fee schedule" }]}]} , { "description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [ { "code": "301", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6430.42,"maximum": 11042.4,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6623.33, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6632.69, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6751.94, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9447.69, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6430.42, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6751.94, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6430.42, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6430.42, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6430.42, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9447.69, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 8696.47, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8233.68, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7716.5, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11042.4, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9967.15, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6430.42, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6430.42, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6430.42, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8359.55, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8553.24, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6687.64, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6430.42, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9384.27, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6430.42, "methodology": "case rate" }]}]} , { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8685.33,"maximum": 17441,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 13707.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 9963.24, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 10361.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 10461.4, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 9963.24, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 12409.5, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 15443, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 13004.8, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 17441, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 9963.24, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 10262.1, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 14822.1, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 13735.7, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 9963.24, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 10461.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 9963.24, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 9963.24, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 9963.24, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 9963.24, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 13707.3, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 11955.9, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 12952.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8685.33, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 9963.24, "methodology": "case rate" }]}]} , { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5986.34,"maximum": 10238.1,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 8063.04, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 8694.55, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6285.66, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6165.93, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6285.66, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 7871.39, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 5986.34, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 8694.55, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 7782.24, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 8700.74, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 5986.34, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 7633.96, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7183.61, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 5986.34, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7304.88, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 5986.34, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 5986.34, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 5986.34, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 5986.34, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 5986.34, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9278.83, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 5986.34, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 10238.1, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6225.79, "methodology": "case rate" }]}]} , { "description": "Remove nasal foreign body", "code_information": [ { "code": "30300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360, "discounted_cash": 163,"minimum": 18.16,"maximum": 360,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 360, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 299.46, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 360, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 360, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 257.28, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 131.16, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 198, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 176.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 360, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 360, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 138.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 288, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 360, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 129.9, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 360, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 100.9, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 360, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 151.34, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 252.24, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 108, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 189.18, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 288, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 360, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 132.43, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 195.49, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" }]}]} , { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK ", "code_information": [ { "code": "3031", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 46424.3,"maximum": 2.81701e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.68287e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.81701e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.68287e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.68287e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 46424.3, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.68287e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.81701e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.68287e+008, "methodology": "case rate" }]}]} , { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK ", "code_information": [ { "code": "3032", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 55864,"maximum": 3.53839e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.53839e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 55864, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.3699e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.53839e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.3699e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.3699e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.3699e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.3699e+008, "methodology": "case rate" }]}]} , { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK ", "code_information": [ { "code": "3033", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 81846.4,"maximum": 5.04256e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.80243e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.04256e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.04256e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.80243e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.80243e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.80243e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 81846.4, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.80243e+008, "methodology": "case rate" }]}]} , { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK ", "code_information": [ { "code": "3034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 111182,"maximum": 7.39957e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 7.04721e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 7.04721e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 7.04721e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 7.39957e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 7.04721e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 7.39957e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7.04721e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 111182, "methodology": "case rate" }]}]} , { "description": "HYPERTENSION WITH MCC", "code_information": [ { "code": "304", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7367.44,"maximum": 17875,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10202.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 15190.9, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10202.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10202.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 13851.2, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 17875, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 13328.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 13851.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 12539.8, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 13263.8, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 10713, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10202.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10202.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10202.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 10713, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10202.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 10509, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 12243.5, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 10611, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10202.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 15814.5, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10202.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7367.44, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14077.5, "methodology": "case rate" }]}]} , { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK ", "code_information": [ { "code": "3041", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 28218.3,"maximum": 1.84878e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 28218.3, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.76075e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.76075e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.76075e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.84878e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.84878e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.76075e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.76075e+008, "methodology": "case rate" }]}]} , { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK ", "code_information": [ { "code": "3042", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 33797.4,"maximum": 2.27977e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.17121e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.27977e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.17121e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.27977e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.17121e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 33797.4, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.17121e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.17121e+008, "methodology": "case rate" }]}]} , { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK ", "code_information": [ { "code": "3043", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 50900.7,"maximum": 3.33691e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 3.17801e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 3.17801e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 3.17801e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.33691e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 50900.7, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 3.17801e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3.17801e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.33691e+008, "methodology": "case rate" }]}]} , { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK ", "code_information": [ { "code": "3044", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 84775.2,"maximum": 5.188e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 4.94096e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 4.94096e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 5.188e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 4.94096e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 4.94096e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4.94096e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 84775.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 5.188e+008, "methodology": "case rate" }]}]} , { "description": "HYPERTENSION WITHOUT MCC", "code_information": [ { "code": "305", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6805.78,"maximum": 11722.2,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7146.07, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6805.78, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9962.02, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8166.94, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6805.78, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6805.78, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6805.78, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6805.78, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6805.78, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7146.07, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11722.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6805.78, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6805.78, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6805.78, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9369.52, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9369.52, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8482.47, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9231.88, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 7078.01, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8740.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10549, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6904.97, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8847.51, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7009.95, "methodology": "case rate" }]}]} , { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES ", "code_information": [ { "code": "3051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 10581.5,"maximum": 6.98169e+007,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 6.64923e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 6.98169e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 6.64923e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 6.64923e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 10581.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 6.64923e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 6.98169e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6.64923e+007, "methodology": "case rate" }]}]} , { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES ", "code_information": [ { "code": "3052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 14487.5,"maximum": 9.5762e+007,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.12019e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.12019e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.5762e+007, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.5762e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.12019e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 14487.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.12019e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.12019e+007, "methodology": "case rate" }]}]} , { "description": "Repair of nasal septum", "code_information": [ { "code": "30520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10995.3, "discounted_cash": 4132,"minimum": 18.16,"maximum": 8796.24,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 3337.73, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 823, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 823, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 905.3, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 3274.15, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3298.59, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2709.44, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 823, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2543.03, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 3814.55, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4450.31, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1492, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8796.24, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3178.79, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 8796.24, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7547.76, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 3305.94, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 4927.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 3419.44, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 6047.41, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6484.73, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 6357.58, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 3496.67, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 4768.19, "methodology": "fee schedule" }]}]} , { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES ", "code_information": [ { "code": "3053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 23707.2,"maximum": 1.5134e+008,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.5134e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.44133e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.5134e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.44133e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 23707.2, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.44133e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.44133e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.44133e+008, "methodology": "case rate" }]}]} , { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES ", "code_information": [ { "code": "3054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 50143.1,"maximum": 2.84353e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.70812e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 50143.1, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.70812e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.70812e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.84353e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.70812e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.70812e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.84353e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7552.99,"maximum": 23908,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 13939.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13533.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 20977.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7552.99, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 13533.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 23908, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 17917.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 13533.9, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 17917.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 13533.9, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 13533.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 18828.9, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 14075.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13533.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 17826.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 13533.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13533.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 20318, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 14210.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 16240.6, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 13533.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 14210.5, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 17594, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 16220.9, "methodology": "case rate" }]}]} , { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 8056.78,"maximum": 14664,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 10011.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 11058.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 8056.78, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 11058.2, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 8430.04, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10959, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8430.04, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 8430.04, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10934.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 8430.04, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8851.54, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 14664, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 11548.7, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 13066.6, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 8682.94, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 8430.04, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8851.54, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8430.04, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 8430.04, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 10116, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8767.24, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8430.04, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8430.04, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12462.1, "methodology": "case rate" }]}]} , { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6707.27,"maximum": 18702.6,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 10659.9, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 16522.8, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 10659.9, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 10979.7, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 13857.8, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 10659.9, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 18702.6, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 15894.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6707.27, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 11192.8, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 11086.2, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 10659.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 10659.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 13945.5, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 15371.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 10659.9, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10659.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 10659.9, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 14729.4, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 13915.9, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 11192.8, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 15371.1, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 12791.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10659.9, "methodology": "case rate" }]}]} , { "description": "HIP & FEMUR FRACTURE REPAIR ", "code_information": [ { "code": "3081", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12827.1,"maximum": 9.30351e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 9.30351e+007, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.86049e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.86049e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.86049e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 9.30351e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.86049e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.86049e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12827.1, "methodology": "case rate" }]}]} , { "description": "HIP & FEMUR FRACTURE REPAIR ", "code_information": [ { "code": "3082", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15112.5,"maximum": 1.09483e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.0427e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.0427e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.09483e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.0427e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.0427e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15112.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.0427e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.09483e+008, "methodology": "case rate" }]}]} , { "description": "HIP & FEMUR FRACTURE REPAIR ", "code_information": [ { "code": "3083", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 20173.5,"maximum": 1.45381e+008,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.38458e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.38458e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 20173.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.38458e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.45381e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.38458e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.45381e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.38458e+008, "methodology": "case rate" }]}]} , { "description": "HIP & FEMUR FRACTURE REPAIR ", "code_information": [ { "code": "3084", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 35264.9,"maximum": 2.23434e+008,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.12794e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.12794e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.23434e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 35264.9, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.12794e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.12794e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.12794e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.23434e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6236.89,"maximum": 11585.3,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8749.26, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8638.52, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 11585.3, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9845.68, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 9910.5, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 10431.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 7066.71, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 8076.24, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6932.11, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6730.2, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6999.41, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8972.23, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 9124.06, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 9910.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6236.89, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 7066.71, "methodology": "case rate" }]}]} , { "description": "Control of nosebleed", "code_information": [ { "code": "30901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 554.88, "discounted_cash": 163,"minimum": 18.16,"maximum": 554.88,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 166.46, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 305.18, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 131.16, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 554.88, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 138.73, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 554.88, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 27, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 554.88, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 554.88, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 252.24, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 423.35, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 534.29, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 443.9, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 195.49, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 554.88, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 28.62, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 129.9, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 257.28, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 132.43, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 151.34, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 299.46, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 176.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 443.9, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 100.9, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 189.18, "methodology": "fee schedule" }]}]} , { "description": "CONTROL NASAL HEMORRAGE, COMPLEX", "code_information": [ { "code": "30903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 620, "discounted_cash": 163,"minimum": 18.16,"maximum": 620,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 138.73, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 132.43, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 397, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 40.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 397, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 257.28, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 129.9, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 189.18, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 252.24, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 42.93, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 620, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 299.46, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 186, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 341, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 195.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 620, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 496, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 176.57, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 496, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 100.9, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 436.7, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 151.34, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 620, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 397, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 131.16, "methodology": "fee schedule" }]}]} , { "description": "Control of nosebleed", "code_information": [ { "code": "30905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 625, "discounted_cash": 163,"minimum": 18.16,"maximum": 625,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 343.75, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 252.24, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 625, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 189.18, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 100.9, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 187.5, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 129.9, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 625, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 79.5, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 625, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 195.49, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 625, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 257.28, "methodology": "fee schedule" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 132.43, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 625, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 131.16, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 151.34, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 138.73, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 625, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 500, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 299.46, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 500, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 176.57, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 126.12, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 84.27, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 625, "methodology": "fee schedule" }]}]} , { "description": "REPEAT CONTROL OF NOSEBLEED", "code_information": [ { "code": "30906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 720.56, "discounted_cash": 313,"minimum": 18.16,"maximum": 720.56,"payers_information":[{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 79.5, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 361.74, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 720.56, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 720.56, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 491.97, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 720.56, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 482.32, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 216.17, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 373.8, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 720.56, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 250.81, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 720.56, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 572.61, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 289.39, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 337.62, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 720.56, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 576.45, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 84.27, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 396.31, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 265.28, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 576.45, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 720.56, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 253.22, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 248.39, "methodology": "fee schedule" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 192.93, "methodology": "fee schedule" }]}]} , { "description": "OTHER SIGNIFICANT HIP & FEMUR SURGERY ", "code_information": [ { "code": "3091", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12943.5,"maximum": 1.02931e+008,"payers_information":[{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.803e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12943.5, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.803e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.02931e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.02931e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.803e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.803e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.803e+007, "methodology": "case rate" }]}]} , { "description": "OTHER SIGNIFICANT HIP & FEMUR SURGERY ", "code_information": [ { "code": "3092", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 18399.8,"maximum": 1.33182e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18399.8, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.33182e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.2684e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.2684e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.2684e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.2684e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.33182e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.2684e+008, "methodology": "case rate" }]}]} , { "description": "OTHER SIGNIFICANT HIP & FEMUR SURGERY ", "code_information": [ { "code": "3093", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 26862.9,"maximum": 1.93433e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.84222e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.84222e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.84222e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 26862.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.84222e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.93433e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.93433e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.84222e+008, "methodology": "case rate" }]}]} , { "description": "OTHER SIGNIFICANT HIP & FEMUR SURGERY ", "code_information": [ { "code": "3094", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 52525.2,"maximum": 2.94306e+008,"payers_information":[{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 52525.2, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.94306e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.94306e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.80291e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.80291e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.80291e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.80291e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.80291e+008, "methodology": "case rate" }]}]} , { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 5083.61,"maximum": 8603.02,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 5236.12, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 7414.07, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 5083.61, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 5083.61, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 7879.6, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 6414.8, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 5083.61, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 5083.61, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 5337.79, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7311.21, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 5083.61, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 5083.61, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 5083.61, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 7414.07, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 6608.69, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 6712.15, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 5286.95, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 5337.79, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 5955.41, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 8603.02, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 5083.61, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6775.36, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 5083.61, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 6100.33, "methodology": "case rate" }]}]} , { "description": "IRRIGATION MAXILLARY SINUS", "code_information": [ { "code": "31000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1420.75, "discounted_cash": 313,"minimum": 18.16,"maximum": 1420.75,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 337.62, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 781.41, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 1420.75, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1136.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 253.22, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 1136.6, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 361.74, "methodology": "fee schedule" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 248.39, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 482.32, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 250.81, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 572.61, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 289.39, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 373.8, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1420.75, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1420.75, "methodology": "case rate" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 192.93, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 426.23, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 265.28, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 1420.75, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 241.16, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 491.97, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1420.75, "methodology": "case rate" }]}]} , { "description": "VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES", "code_information": [ { "code": "3101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 9645.11,"maximum": 8.48361e+007,"payers_information":[{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 8.48361e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 8.07963e+007, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 8.07963e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 8.07963e+007, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 8.07963e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 9645.11, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 8.07963e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 8.48361e+007, "methodology": "case rate" }]}]} , { "description": "VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES", "code_information": [ { "code": "3102", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 12803.6,"maximum": 1.13864e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.08441e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.13864e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.13864e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.08441e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 12803.6, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.08441e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.08441e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.08441e+008, "methodology": "case rate" }]}]} , { "description": "VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES", "code_information": [ { "code": "3103", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 18526.6,"maximum": 1.57049e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.57049e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.49571e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.49571e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.49571e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18526.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.57049e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.49571e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.49571e+008, "methodology": "case rate" }]}]} , { "description": "VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES", "code_information": [ { "code": "3104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 39832.6,"maximum": 3.00483e+008,"payers_information":[{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 3.00483e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.86174e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.86174e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.86174e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.86174e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 39832.6, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3.00483e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.86174e+008, "methodology": "case rate" }]}]} , { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 6329.92,"maximum": 10860.3,"payers_information":[{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 8115.15, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 8553.12, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 8963.79, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6329.92, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 9811.38, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 6838.53, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8228.9, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 6329.92, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 6329.92, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 6329.92, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 6329.92, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 8097.96, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 8963.79, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6329.92, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 6646.42, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 6519.82, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 10860.3, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6329.92, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 6583.12, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 7595.9, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 6329.92, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9229.58, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6329.92, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 6646.42, "methodology": "case rate" }]}]} , { "description": "SYNCOPE AND COLLAPSE", "code_information": [ { "code": "312", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 7210.13,"maximum": 13433.5,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7750.62, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Exchange", "standard_charge_dollar": 7210.13, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 8138.15, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 10579.6, "methodology": "case rate" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 12013.5, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 7750.62, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 9300.74, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11416.3, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 8138.15, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7750.62, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 9399.08, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 7750.62, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7750.62, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 7750.62, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 8060.64, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 7750.62, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 7983.14, "methodology": "case rate" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 13433.5, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7750.62, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 10382, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 10382, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10075.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 10016.6, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 7750.62, "methodology": "case rate" }]}]} , { "description": "SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES ", "code_information": [ { "code": "3121", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 15901.9,"maximum": 1.01565e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 9.67285e+007, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.01565e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.01565e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 9.67285e+007, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 15901.9, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 9.67285e+007, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9.67285e+007, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 9.67285e+007, "methodology": "case rate" }]}]} , { "description": "SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES ", "code_information": [ { "code": "3122", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 22631.2,"maximum": 1.56269e+008,"payers_information":[{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 1.48828e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1.48828e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1.56269e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 1.56269e+008, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 1.48828e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 22631.2, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 1.48828e+008, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 1.48828e+008, "methodology": "case rate" }]}]} , { "description": "SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES ", "code_information": [ { "code": "3123", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient","minimum": 40808.8,"maximum": 2.57254e+008,"payers_information":[{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 2.45004e+008, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2.45004e+008, "methodology": "case rate" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2.57254e+008, "methodology": "case rate" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 2.45004e+008, "methodology": "case rate" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 40808.8, "methodology": "case rate" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 2.45004e+008, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 2.45004e+008, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 2.57254e+008, "methodology": "case rate" }]}]} , { "description": "Nasal endoscopy dx", "code_information": [ { "code": "31231", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 731, "discounted_cash": 254,"minimum": 18.16,"maximum": 731,"payers_information":[{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 201.43, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "standard_charge_dollar": 731, "methodology": "case rate" } ,{ "payer_name": "Spartan", "plan_name": "Spartan Plan", "standard_charge_dollar": 205.34, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 234.67, "methodology": "fee schedule" } ,{ "payer_name": "Non-contracted Medicaid", "plan_name": "Non-contracted Medicaid", "standard_charge_dollar": 731, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 195.56, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 731, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC VA CCN", "standard_charge_dollar": 195.56, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 464.34, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 584.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 195.56, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 731, "methodology": "case rate" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "standard_charge_dollar": 195.56, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 584.8, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 731, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 219.3, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 156.45, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 195.56, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna HealthSpring", "standard_charge_dollar": 195.56, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 273.78, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 303.12, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 195.56, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 195.56, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 731, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 195.56, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 731, "methodology": "case rate" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 731, "methodology": "case rate" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 215.12, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 391.12, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 293.34, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 195.56, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "standard_charge_dollar": 402.05, "standard_charge_percentage": 55.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "standard_charge_dollar": 203.38, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 398.94, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 731, "methodology": "fee schedule" }]}]} , { "description": "NSL/SINS NDSC DX MAX SINUSC", "code_information": [ { "code": "31233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6348.95, "discounted_cash": 524,"minimum": 18.16,"maximum": 5079.16,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 403.14, "methodology": "fee schedule" } ,{ "payer_name": "Naphcare", "plan_name": "Naphcare ", "standard_charge_dollar": 624.87, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 403.14, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2000, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5079.16, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicare", "standard_charge_dollar": 443.45, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "standard_charge_dollar": 2778.3, "methodology": "case rate" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "standard_charge_dollar": 2201.42, "methodology": "case rate" } ,{ "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "standard_charge_dollar": 415.23, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "standard_charge_dollar": 403.14, "methodology": "fee schedule" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "standard_charge_dollar": 776, "methodology": "fee schedule" } ,{ "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "standard_charge_dollar": 403.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "standard_charge_dollar": 604.71, "methodology": "fee schedule" } ,{ "payer_name": "Keystone", "plan_name": "Keystone first Medicaid", "standard_charge_dollar": 3425, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 403.14, "methodology": "fee schedule" } ,{ "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 822.41, "methodology": "fee schedule" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial", "standard_charge_dollar": 806.28, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1904.68, "standard_charge_percentage": 30.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Highmark", "plan_name": "Highmark Commercial Exchange", "standard_charge_dollar": 5079.16, "standard_charge_percentage": 80.0000, "methodology": "percent of total billed charges" } ,{ "payer_name": "PA health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "standard_charge_dollar": 483.77, "methodology": "fee schedule" } ,{ "payer_name": "NJ MCD HMO", "plan_name": "NJ MCD HMO", "standard_charge_dollar": 18.16, "standard_charge_percentage": 18.8400,"standard_charge_algorithm": "Not To Exceed $18.16", "methodology": "percent of total billed charges" } ,{ "payer_name": "Gateway Health Plan", "plan_name": "Gateway Health Plan Medicaid", "standard_charge_dollar": 853.6, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 403.14, "methodology": "fee schedule" } ,{ "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "standard_charge_dollar": 403.14, "methodology": "fee schedule" } ,{